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MINI 18 - Radiation Topics in Localized NSCLC (ID 139)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
MINI18.14 - Pre-Existing Pulmonary Fibrosis Increases the Risk of Radiation Pneumonitis (ID 557)
16:45 - 18:15 | Author(s): J. Murchison
Radiation pneumonitis is a potentially life-threatening complication of curative radiotherapy in individuals with lung cancer. Predicting which patients are at higher risk of pneumonitis is constrained by limited understanding of its causes. The aim of this study was to examine patient characteristics and radiological factors associated with increased risk of radiation pneumonitis in individuals with lung cancer receiving curative radiotherapy.
Individuals with lung cancer treated with curative radiotherapy between January and June 2009 were identified from our departmental database. Data were extracted on patient sex, age and smoking status, lobe affected by cancer, pathology, T and N stage, radiation dose delivered, the use of concurrent chemotherapy, and the grade of fibrosis present on the diagnostic CT scan. The CT scans were reviewed and the fibrosis scored by two pulmonary radiologists. CTCAEv3.0 toxicity scores were used to grade the pneumonitis. Mann-Whitney, chi-squared and Fisher exact tests were used to determine the impact of the various factors on the risk of developing pneumonitis.
84 patients were identified who underwent curative radiotherapy for lung cancer between January and June 2009. The minimum follow-up for the cohort was 5 years. One year and 3 year survival were 61.9% and 29.8% respectively. 8/84 patients (9.5%) developed significant pneumonitis (CTCAEv3 grade 3 - 5). 6/22 (27.3%) patients with fibrosis on their diagnostic CT developed grade 3 - 5 pneumonitis compared with 2/58 (3.4%) of patients with no fibrosis on the diagnostic CT (Fisher exact test, p=0.0042). Low grade pneumonitis had no impact on survival (grade 0, median survival 80 weeks, grade 1 - 2, median survival 78 weeks) whereas median survival was reduced to 16 weeks in those with grade 3 - 5 pneumonitis. One out of 8 patients in this group survived one year. Only the presence of fibrosis on the diagnostic CT scan and continued tobacco use affected the risk of developing pneumonitis with fibrosis increasing the risk of developing pneumonitis (relative risk 7.9, p < 0.04) and continued tobacco use reducing the risk (relative risk 0.3, p < 0.02). There appeared to be a trend between the fibrosis score on the baseline scan and the risk of developing pneumonitis which did not achieve statistical significance
The data from this small study suggest radiation pneumonitis affects approximately 1 in 10 individuals receiving curative radiotherapy for lung cancer. The presence of pulmonary fibrosis on the diagnostic CT scan increased the risk of developing pneumonitis. Consideration should be given to alternative treatment options for these patients.
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