Predictors of radiation pneumonitis and pulmonary function changes after concurrent chemoradiotherapy of non-small cell lung cancer

Abstract

Purpose: To evaluate the predictive factors of radiation pneumonitis (RP) and associated changes in pulmonary function after definitive concurrent chemoradiotherapy (CCRT) in patients with non-small cell lung cancer (NSCLC).

Materials and methods: Medical records of 60 patients with NSCLC who received definitive CCRT were retrospectively reviewed. Dose volumetric (DV) parameters, clinical factors, and pulmonary function test (PFT) data were analyzed. RP was graded according to the CTCAE ver. 4.0. Percentage of lung volume that received a dose of threshold (Vdose) and mean lung dose (MLD) were analyzed for potential DV predictors. PFT changes were calculated as the difference between pre-RT and post-RT values at 3, 6, and 12 months after RT.

Results: Twenty-two patients (37%) developed grade ≥2 RP. Among clinical factors, tumor location in lower lobe was associated with RP. Among the DV parameters, only MLD >15 Gy was associated with grade ≥2 RP. There were statistically significant decreases in PFT at all points compared with pre-RT values in grade ≥2 RP group. MLD was associated with forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) changes at 6 and 12 months. V10 was associated with FVC changes at 12 months. V20 and V30 were associated with FEV1 changes at 6 months and FVC changes at 12 months.

Conclusion: After definitive CCRT in patients with NSCLC, MLD >15 Gy and lower lobe tumor location were predictors of grade ≥2 RP. Pulmonary functions were decreased after CCRT and the magnitude of changes was associated with DV parameters.

Keywords: Dose volumetric parameter; Non-small-cell lung carcinoma; Radiation pneumonitis; Respiratory function test.

Fig. 1

The changes of pulmonary functions (FVC, FEV1, and DLCO) after CCRT. The relative changes of pulmonary function were difference between the pre- and post-RT PFT values relative to the pre-RT values. p-values are from paired t-test. RP, radiation pneumonitis; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; DLCO, diffusion capacity for carbon monoxide; CCRT, concurrent chemoradiotherapy; RT, radiotherapy; PFT, pulmonary function tests.