Factors affecting post-treatment radiation-induced lung disease in patients receiving stereotactic body radiotherapy to
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ORIGINAL ARTICLE
Factors affecting post‑treatment radiation‑induced lung disease in patients receiving stereotactic body radiotherapy to lung Pervin Hurmuz1 · Mustafa Cengiz1 · Caglayan Selenge Beduk Esen1 · Yagiz Yedekci1 · Zehra Yildiz1 · Gokhan Ozyigit1 · Faruk Zorlu1 · Fadil Akyol1 Received: 28 June 2020 / Accepted: 12 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The aim of the study is to investigate factors that may cause radiation-induced lung disease (RILD) in patients undergoing stereotactic body radiotherapy (SBRT) for lung tumors. Medical records of patients treated between May 2018 and June 2019 with SBRT were retrospectively evaluated. All patients should have a diagnosis of either primary non-small cell lung cancer (NSCLC) or less than three metastases to lung from another primary. The median treatment dose was 50 Gy in 4–5 fractions. Tumor response and RILD were evaluated in thoracic computer tomography (CT) using RECIST criteria. 82 patients with 97 lung lesions were treated. The median age was 68 years (IQR = 62–76). With a median follow-up of 7.2 months (3–18 months), three patients had grade 3 radiation pneumonitis (RP). RILD was observed in 52% of cases. Patients who had RILD had a higher risk of symptomatic RP (p = 0.007). In multivariate analyses older age, previous lung radiotherapy history, and median planning treatment volume (PTV) D95 value of ≥ 48 Gy were associated with RILD. Local recurrence (LR) was observed in 5.1% of cases. There was no difference in overall survival and LR with the presence of RILD. Older age, previous lung radiotherapy history, and median PTV D95 value of ≥ 48 Gy seems to be associated with post-SBRT RILD. Keywords SBRT · SABR · Lung · Radiation-induced lung disease · Radiotherapy
Introduction Radiation therapy (RT) is a major treatment modality for the management of non-small cell lung cancer (NSCLC). Recent advances in RT technology allow delivering higher doses of radiation to the tumor. However, the lung is a radiosensitive organ, and the delivery of high doses of radiation has been largely limited by normal tissue injury that is defined as radiation-induced lung disease (RILD). In conventional (chemo) radiotherapy radiological RILD has been classically described as having two phases; the acute phase, referred to as radiation pneumonitis (RP) (within 1–3 months after RT) and the chronic phase, referred to as fibrosis (observed several months after RT and may progress slowly for months to years). Stereotactic body RT (SBRT) enables the delivery of a very high radiation dose to the target volume while * Pervin Hurmuz [email protected]; [email protected] 1
minimizing the dose to the adjacent normal tissues. Similar to conventional RT-induced changes detected by computerized tomography (CT), CT findings after lung SBRT can be classified into two phases: the acute phase (within 6 months after SBRT) and the chronic phase (later than 6 months). In most cases, radiologic changes of normal lung tissue
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