Interstitial Lung Change in Pre-radiation Therapy Computed Tomography Is a Risk Factor for Severe Radiation Pneumonitis
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Purpose We examined clinical and dosimetric factors as predictors of symptomatic radiation pneumonitis(RP) in lung cancer patients and evaluated the relationship between interstitial lungchanges in the pre-radiotherapy (RT) computed tomography (CT) and symptomatic RP. Materials and MethodsMedical records and dose volume histogram data of 60 lung cancer patients from August2005 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 clinicaland dosimetric factors. ResultsWith a median follow-up of 15.5 months (range, 6.1 to 40.9 months), Radiation TherapyOncology 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), andV30 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 complicationprobability (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 andreceived chemoradiotherapy. ConclusionOur study identified diffuse interstitial disease as a significant clinical risk for RP, particularlyfatal RP. We showed the usefulness of MLD, V20, V30, and NTCP in predicting the incidenceand severity of RP.
Abstract
Purpose We examined clinical and dosimetric factors as predictors of symptomatic radiation pneumonitis(RP) in lung cancer patients and evaluated the relationship between interstitial lungchanges in the pre-radiotherapy (RT) computed tomography (CT) and symptomatic RP. Materials and MethodsMedical records and dose volume histogram data of 60 lung cancer patients from August2005 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 clinicaland dosimetric factors. ResultsWith a median follow-up of 15.5 months (range, 6.1 to 40.9 months), Radiation TherapyOncology 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), andV30 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 complicationprobability (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 andreceived chemoradiotherapy. ConclusionOur study identified diffuse interstitial disease as a significant clinical risk for RP, particularlyfatal RP. We showed the usefulness of MLD, V20, V30, and NTCP in predicting the incidenceand severity of RP.
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