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ORIGINAL ARTICLE
Year : 2013  |  Volume : 9  |  Issue : 3  |  Page : 447-451

Acute radiation pneumonitis after conformational radiotherapy for nonsmall cell lung cancer: Clinical, dosimetric, and associated-treatment risk factors


1 Department of Respiratory Diseases, Hôpital Ambroise Paré, 9 Avenue Charles-de-Gaulle 92100 Boulogne-Billancourt; University Versailles-Saint Quentin en Yvelines, 9 Boulevard d'Alembert, 78280 Guyancourt, France
2 Department of Radiation Oncology, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015 Paris, France
3 Department of Biostatistics, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris; University Paris Descartes, 15 rue de l'Ecole de Médecine, 75006 Paris, France
4 Department of Radiation Oncology, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015 Paris; University Paris Descartes, 15 rue de l'Ecole de Médecine, 75006 Paris, France

Correspondence Address:
Etienne Giroux Leprieur
Department of Respiratory Diseases, Hôpital Ambroise Paré, 09 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt
France
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.119339

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Background: Conformational thoracic radiotherapy (CTR) is a key-treatment in locally advanced nonsmall cell lung cancer (LA-NSCLC). Acute radiation pneumonitis (ARP) is one of the major complications. Aims: To evaluate the predictors of ARP after CTR in the treatment of LA-NSCLC. Materials and methods: A total of 47 consecutive patients (pts) were treated with CTR for LA-NSCLC and retrospectively analyzed. The mean total dose of radiation therapy (RT) was 65 Gy, with respiratory gating (RG) in 19 cases. Induction and concomitant chemotherapy was performed in 33 pts (70%) and 41 pts (87%), respectively. Results: Eleven pts (23%) had an ARP resulting in death for one pt. In univariate analysis, age, sex, pretherapeutic value of forced expiratory volume (FEV), not-gated radiotherapy and type of concomitant chemotherapy did not appear as contributing factors in contrast to the administration of induction gemcitabine ( p = 0.03). The occurrence of ARP was significantly associated with nontumor lung volumes irradiated to 13 Gy (V13, p = 0.04), 20 Gy (V20, p = 0.02), and 25 Gy (V25, p = 0.006), the mean lung dose ( p = 0.008) and lung normal tissue complication probability (NTCP) ( p = 0.004). In multivariate logistic regression analysis, the occurrence of ARP was significantly associated with age >75 years (odds ratio (OR) = 16.72, confidence interval (CI) 95% 1.77-157.87) and administration of induction gemcitabine (OR = 18.08, CI 95% 1.09-300.08). Conclusion: ARP is a common acute complication, requiring close posttreatment follow-up, particularly for elderly patients. The use of gemcitabine before radiation should be avoided. The benefits and risks of CTR must be carefully analyzed, according to the dosimetric parameters.


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