Interstitial Lung Change in Pre-radiation Therapy Computed Tomography Is a Risk Factor for Severe Radiation Pneumonitis

• Published in: Cancer research and treatment 2015, 47(4), , pp.676-686
• Main Authors: Lee, Yun Hee, Kim, Yeon Sil, Lee, Sang Nam, Lee, Hyo Chun, Oh, Se Jin, Kim, Seoung Joon, Kim, Young Kyoon, Han, Dae Hee, Yoo, Ie Ryung, Kang, Jin Hyung, Hong, Suk Hee
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Female; Humans; Lung - diagnostic imaging; Lung - pathology; Lung - radiation effects; Lung Neoplasms - complications; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - radiotherapy; Male; Middle Aged; Original; Radiation Pneumonitis - complications; Radiation Pneumonitis - diagnostic imaging; Radiometry; Risk Factors; Tomography, X-Ray Computed; 의약학
• ISSN: 1598-2998; 2005-9256
• DOI: 10.4143/crt.2014.180

We examined clinical and dosimetric factors as predictors of symptomatic radiation pneumonitis (RP) in lung cancer patients and evaluated the relationship between interstitial lung changes in the pre-radiotherapy (RT) computed tomography (CT) and symptomatic RP. Medical records and dose volume histogram data of 60 lung cancer patients from August 2005 to July 2006 were analyzed. All patients were treated with three dimensional (3D) conformal RT of median 56.9 Gy. We assessed the association of symptomatic RP with clinical and dosimetric factors. With a median follow-up of 15.5 months (range, 6.1 to 40.9 months), Radiation Therapy Oncology Group grade ≥ 2 RP was observed in 14 patients (23.3%). Five patients (8.3%) died from RP. The interstitial changes in the pre-RT chest CT, mean lung dose (MLD), and V30 significantly predicted RP in multivariable analysis (p=0.009, p < 0.001, and p < 0.001, respectively). MLD, V20, V30, and normal tissue complication probability normal tissue complication probability (NTCP) were associated with the RP grade but less so for grade 5 RP. The risk of RP grade ≥ 2, ≥ 3, or ≥ 4 was higher in the patients with interstitial lung change (grade 2, 15.6% to 46.7%, p=0.03; grade 3, 4.4% to 40%, p=0.002; grade 4, 4.4% to 33.3%, p=0.008). Four of the grade 5 RP patients had diffuse interstitial change in pre-RT CT and received chemoradiotherapy. Our study identified diffuse interstitial disease as a significant clinical risk for RP, particularly fatal RP. We showed the usefulness of MLD, V20, V30, and NTCP in predicting the incidence and severity of RP.