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Association of lung fluorodeoxyglucose uptake with radiation pneumonitis after concurrent chemoradiation for non-small cell lung cancer.

ABSTRACT: Background:Increased uptake of fluorodeoxyglucose (FDG) by lung tissue could reflect inflammatory changes related to radiation pneumonitis (RP). In this secondary analysis of a clinical trial, we examined potential associations between posttreatment lung FDG uptake and RP severity in patients with non-small cell lung cancer (NSCLC) for up to 12 months after concurrent chemoradiation (CRT). Methods:Subjects were 152 patients with NSCLC who had received concurrent CRT as part of the prospective trial NCT00915005. The following lung FDG variables were evaluated after CRT: maximum, mean, and peak standardized uptake values (SUVmax, SUVmean, SUVpeak) and global lung glycolysis (GLG; lung SUVmean × lung volume). RP severity was scored with the Common Terminology Criteria for Adverse Events v3.0. Results:Significant associations were noted between PET findings and RP severity at 1-6 months (all P < 0.05), but not at 7-12 months after therapy (all P > 0.05). Lung FDG uptake at 1-3 months after treatment predicted later development of grade ?2 RP (all P < 0.05), with cutoff values as follows: 4.54 for SUVmax, 3.69 for SUVpeak, 0.78 for SUVmean, and 2295 for GLG. Conclusions:Lung FDG uptake correlated significantly with RP severity during the first 6 months after CRT. The cutoff values seem clinically meaningful for identifying patients at risk of developing RP after such therapy.

SUBMITTER: Yue J

PROVIDER: S-EPMC5833918 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Association of lung fluorodeoxyglucose uptake with radiation pneumonitis after concurrent chemoradiation for non-small cell lung cancer.

Yue Jinbo J McKeever Matthew M Sio Terence T TT Xu Ting T Huo Jinhai J Shi Qiuling Q Nguyen Quynh-Nhu QN Komaki Ritsuko R Gomez Daniel R DR Pan Tinsu T Wang Xin Shelley XS Liao Zhongxing Z

Clinical and translational radiation oncology 20170511

<h4>Background</h4>Increased uptake of fluorodeoxyglucose (FDG) by lung tissue could reflect inflammatory changes related to radiation pneumonitis (RP). In this secondary analysis of a clinical trial, we examined potential associations between posttreatment lung FDG uptake and RP severity in patients with non-small cell lung cancer (NSCLC) for up to 12 months after concurrent chemoradiation (CRT).<h4>Methods</h4>Subjects were 152 patients with NSCLC who had received concurrent CRT as part of the ...[more]

PMID: 29594201

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Project description:BackgroundLocally advanced non-small cell lung cancer (LA-NSCLC) treated with the programmed death-ligand 1 inhibitor durvalumab has been associated with significant rates of pneumonitis, which has led to higher rates of discontinuation of therapy in real-world populations. Thus far there has been no consensus in the literature on the impact of pneumonitis on survival.MethodsThis is a retrospective cohort study of veterans receiving durvalumab between 12/5/2017 and 4/15/2020. Participants were identified using VINCI data services. Patients were followed through 9/14/2021. Development of clinical pneumonitis was assessed through review of documentation and graded using CTCAE 4.0 criteria. Univariate logistic regression analysis evaluated for associations between body mass index (BMI), age, race, co-morbidity index, chemotherapy regimen, chronic obstructive pulmonary disease (COPD) severity, and development of clinical pneumonitis. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier methods. Cox proportional hazards models were utilized to evaluate the association between risk of death at 1 and 2 years and candidate predictor variables.ResultsA total of 284 patients were included in this study. Sixty-one patients developed clinically significant pneumonitis, 7 patients developed grade 5 pneumonitis (death from pneumonitis). The median OS in patients that developed pneumonitis was 27.8 vs. 36.9 months in patients that did not develop pneumonitis (P=0.22). BMI was found to be a clinical predictor of pneumonitis (P=0.04). COPD severity, race, age at durvalumab start date, chemotherapy regimen, and Romano comorbidity index were not significant predictors of pneumonitis. Cox proportional hazards analysis failed to demonstrate an association between the development of pneumonitis and risk of death in this population.ConclusionsThe incidence of clinically significant pneumonitis is higher than noted in the PACIFIC trial in this cohort, however this high rate of pneumonitis does not have an impact on OS or PFS. Obesity was found to be a significant predictor of pneumonitis in this patient population.

Project description:PurposeThis study aimed to investigate the association between target volume margins and clinical outcomes for patients with inoperable non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation therapy.Methods and materialsWe reviewed the records of 82 patients with inoperable NSCLC treated between 2009 and 2016 with concurrent chemoradiation. All patients received positron emission tomography-based treatment planning, 4-dimensional computed tomography simulation to define an internal target volume, and daily cone beam computed tomography. We quantified variations in target volume margins with a margin deviation index (MDI), calculated as the percentage change in equivalent uniform dose between the original planning target volume (PTV) and a standard reference PTV 10 mm beyond the original gross tumor volume, consistent with the minimum margins mandated by recent NSCLC trials. Greater MDIs equated to smaller effective target volume margins. We dichotomized patients by the upper tercile MDI value (5.8%). Endpoints included time to locoregional progression and time to grade ≥ 3 radiation esophagitis (RE3) or radiation pneumonitis (RP3), modelled with the Fine-Gray method.ResultsMedian follow-up was 37.8 months (range, 5.9-58.1 months). Larger MDIs correlated with smaller clinical target volume (CTV) + PTV margins, larger gross tumor volumes, later treatment year, and intensity modulated radiation therapy use. The risk of locoregional progression did not differ for MDI ≥5.8% versus <5.8% (adjusted hazard ratio: 0.88; P = .76), but the risk of RE3 or RP3 was decreased for MDI ≥5.8% (adjusted hazard ratio: 0.27; P = .027). Patients with MDI ≥5.8% were treated with smaller CTV + PTV margins (median, 5.6 vs 8 mm; P < .0001) and a marginally lower volume of esophagus receiving ≥50 Gy (median, 31.1% vs 35.3%; P = .069).ConclusionsSmaller margins were used for larger tumors but were not associated with an increase in locoregional failures. Additional studies could clarify whether smaller margins, when used alongside modern radiation therapy techniques, decrease treatment-related toxicity for inoperable NSCLC.

Dataset Information

Association of lung fluorodeoxyglucose uptake with radiation pneumonitis after concurrent chemoradiation for non-small cell lung cancer.

Publications

Association of lung fluorodeoxyglucose uptake with radiation pneumonitis after concurrent chemoradiation for non-small cell lung cancer.

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