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

Cancer Research and Treatment 2015년 47권 4호 p.676 ~ p.686

이연희(Lee Yun-Hee) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Radiation Oncology
김연실(Kim Yeon-Sil) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Radiation Oncology
이상남(Lee Sang-Nam) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Radiation Oncology
이효천(Lee Hyo-Chun) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Radiation Oncology
오세진(Oh Se-Jin) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Radiation Oncology
(Kim Seoung-Joon) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
김영균(Kim Young-Kyoon) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
한대희(Han Dae-Hee) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Radiology
유이령(Yoo Ie-Ryung) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Nuclear Medicine
강진형(Kang Jin-Hyung) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Medical Oncology
홍석희(Hong Suk-Hee) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Medical Oncology

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 lung changes in the pre-radiotherapy (RT) computed tomography (CT) and symptomatic RP.

Materials and Methods: 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.

Results: 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.

Conclusion: 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.