TY - JOUR
T1 - Radiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-tkis: Radiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-tkis: Is there any difference from stereotactic body radiotherapy alone?
AU - Tang, Xingni
AU - Shen, Yichao
AU - Meng, Yinnan
AU - Hou, Liqiao
AU - Zhou, Chao
AU - Yu, Changhui
AU - Jia, Haijian
AU - Wang, Wei
AU - Ren, Ge
AU - Cai, Jing
AU - Li, X. Allen
AU - Yang, Haihua
AU - Kong, Feng Ming Spring
N1 - Funding Information:
The authors thank all the physicians, physicist and radiographers who have been involved in the development of the stereotactic body radiotherapy program. The abstract of the study has been presented at the 2019 World Conference on Lung Cancer Meeting (September 7–9, Spain). Funding: This work was supported in part by the Chinese National Science Foundation Projects (NSFC 81874221 and 81872458), Shenzhen Science and Technology Program (Grant No. KQTD20180411185028798), Zhejiang Provincial Medicine and Health Foundation (2015KYA240), Science and Technology Agency of Taizhou City (15yw01), China.
Publisher Copyright:
© Annals of Palliative Medicine. All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - Background: To quantitatively evaluate lung damage after treatment of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and stereotactic body radiotherapy (SBRT) in patients with non-small cell lung cancer (NSCLC), and compare that of SBRT only treatment. Methods: Eligible patients from an IRB-approved prospective clinical trial had one month of EGFR-TKIs treatment followed by SBRT (TKI + SBRT) and with 3-month follow-up high resolution CT. NSCLC patients treated with SBRT alone during the same time period without EGFR-TKIs or other systemic therapies were identified as controls. The lung damage was assessed clinically by pneumonitis and quantitatively using by CT intensity (Hounsfield unit, HU) changes. The mean HU values were extracted for regions of the lungs receiving the same dose range at 10 Gy intervals to generate dose-response curves (DRC). The relationship of HU changes and radiation dose was modeled using a Probit model. Results: Four out of 20 (25%) TKI + SBRT patients and none of 19 (0%) SBRT alone patients had developed grade 2 and above pneumonitis (P=0.053), respectively. Sixty percent of TKI + SBRT patients and 30% SBRT alone patients had HU changes of the normal lung density >200 HU, respectively. There were significant differences in the DRC and in lung HU changes between the two groups (all P<0.05). The physical dose for a 50% complication risk (TD50) of CT lung damage was 52 Gy (CI: 46–59) in TKI + SBRT group versus 72 Gy (CI: 58–107) in SBRT alone group (P<0.01). Conclusions: Compared to patients treated with SBRT alone, patients treated with EGFR-TKIs followed by SBRT were more incline to develop radiation pneumonitis, and resulted in greater lung CT intensity changes and steeper dose-CT lung damage response relationship at 3 months post treatment. Future study with larger number of patients and longer follow-up period is warranted to validate this finding.
AB - Background: To quantitatively evaluate lung damage after treatment of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and stereotactic body radiotherapy (SBRT) in patients with non-small cell lung cancer (NSCLC), and compare that of SBRT only treatment. Methods: Eligible patients from an IRB-approved prospective clinical trial had one month of EGFR-TKIs treatment followed by SBRT (TKI + SBRT) and with 3-month follow-up high resolution CT. NSCLC patients treated with SBRT alone during the same time period without EGFR-TKIs or other systemic therapies were identified as controls. The lung damage was assessed clinically by pneumonitis and quantitatively using by CT intensity (Hounsfield unit, HU) changes. The mean HU values were extracted for regions of the lungs receiving the same dose range at 10 Gy intervals to generate dose-response curves (DRC). The relationship of HU changes and radiation dose was modeled using a Probit model. Results: Four out of 20 (25%) TKI + SBRT patients and none of 19 (0%) SBRT alone patients had developed grade 2 and above pneumonitis (P=0.053), respectively. Sixty percent of TKI + SBRT patients and 30% SBRT alone patients had HU changes of the normal lung density >200 HU, respectively. There were significant differences in the DRC and in lung HU changes between the two groups (all P<0.05). The physical dose for a 50% complication risk (TD50) of CT lung damage was 52 Gy (CI: 46–59) in TKI + SBRT group versus 72 Gy (CI: 58–107) in SBRT alone group (P<0.01). Conclusions: Compared to patients treated with SBRT alone, patients treated with EGFR-TKIs followed by SBRT were more incline to develop radiation pneumonitis, and resulted in greater lung CT intensity changes and steeper dose-CT lung damage response relationship at 3 months post treatment. Future study with larger number of patients and longer follow-up period is warranted to validate this finding.
KW - Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs)
KW - Lung damage
KW - Normal tissue complication probability (NTCP)
KW - Quantitative CT analysis
KW - Stereotactic body radiotherapy (SBRT)
UR - http://www.scopus.com/inward/record.url?scp=85103339079&partnerID=8YFLogxK
U2 - 10.21037/apm-20-1116
DO - 10.21037/apm-20-1116
M3 - Journal article
AN - SCOPUS:85103339079
SN - 2224-5820
VL - 10
SP - 2832
EP - 2842
JO - Annals of palliative medicine
JF - Annals of palliative medicine
IS - 3
ER -
