Journal
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Volume 83, Issue 5, Pages 1573-1579Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ijrobp.2011.10.065
Keywords
Non-small-cell lung cancer; Radiation therapy; Diffusing capacity of lung for carbon monoxide
Funding
- MD Anderson's Cancer Center [CA16672]
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Purpose: Scoring of radiation pneumonitis (RP), a dose-limiting toxicity after thoracic radio-chemotherapy, is subjective and thus inconsistent among studies. Here we investigated whether the extent of change in diffusing capacity of the lung for carbon monoxide (DLCO) after radiation therapy (RT) for non-small-cell lung cancer (NSCLC) could be used as an objective means of quantifying RP. Patients and Methods: We analyzed potential correlations between DLCO and RP in 140 patients who received definitive RT (>= 60 Gy) with or without chemotherapy for primary NSCLC. All underwent DLCO analysis before and after RT. Post-RT DLCO values within 1 week of the RP diagnosis (Grade 0, 1, 2, or 3) were selected and compared with that individual's preradiation values. Percent reductions in DLCO and RP grade were compared by point biserial correlation in the entire patient group and in subgroups stratified according to various clinical factors. Results: Patients experiencing Grade 0, 1, 2, or 3 RP had median percentage changes in DLCO after RT of 10.7%, 13%, 22.1%, or 35.2%. Percent reduction in DLCO correlated with RP Grade <= 1 vs. >= 2 (p = 0.0004). This association held for the following subgroups: age >= 65 years, advanced stage, smokers, use of chemotherapy, volume of normal lung receiving at least 20 Gy >= 30%, and baseline DLCO or forced expiratory volume in 1 second >= 60%. Conclusions: By correlating percent change in DLCO from pretreatment values at the time of diagnosis of RP with RP grade, we were able to identify categories of RP based on the change in DLCO. These criteria provide a basis for an objective scoring system for RP based on change in DLCO. (C) 2012 Elsevier Inc.
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