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J Korean Soc Ther Radiol Oncol > Volume 26(1); 2008 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2008;26(1): 35-44. doi: https://doi.org/10.3857/jkstro.2008.26.1.35
Incidence and Prognostic Factors of Radiation Pneumonitisin NSCLC Treated with Intensity Modulated Radiation Therapy (IMRT)
Myung Se Kim
Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea. mskim@med.yu.ac.kr
To evaluate the incidence and prognostic factors of treatment-related pneumonitis in non-small-cell lung cancer (NSCLC) patients treated with intensity modulated radiation therapy (IMRT).
One-hundred-five patients with NSCLC treated with IMRT between 1 August 2004 and 30 November 2006 were analyzed retrospectively. The mean age of patients was 62.9 years, and squamous carcinomas were confirmed in 81 patients (77%). Sixty-six patients (62.9%) were classified as stage III, and 59 patients had lesions in the right lung. Twenty-seven patients were treated with a dose of 3,060 cGy preoperatively, and 10 patients were given a dose of 5,040 cGy postoperatively. Sixty-eight patients received a dose of 7,020 cGy for curative intent. Sixty-eight patients were treated with the use of the CORVUS planning system and 37 patients were treated with the use of the ECLIPSE planning system.
Of 105 patients, 21 patients (20%) had abnormal radiological findings, but only seven patients (6.7%) required treatment for radiation pneumonitis. Six of the seven patients had other serious lesions, including a bronchioesophageal fistula (one patient), recurrence in the treatment field (two patients), brain metastasis (one patient) and lung-to-lung metastasis (two patients); all of these patients died within 19 months after radiation treatment. Sixteen patients (23.5%) that received planning with the CORVUS system had abnormal lung findings. Five patients (13.5%) had abnormal lung findings with the use of the ECLIPSE planning system. Other prognostic factors such as perioperative radiation therapy, a volume over 10% of the V20 volume in the right lung, were also statistically significant.
This retrospective analysis suggests that IMRT could be a beneficial treatment modality for the reduction of radiation pneumonitis in NSCLC patients. However, the higher incidence of abnormal radiological findings in perioperative patients treated with relatively lower doses (3,060~5,040 cGy) suggest the need for judicious treatment planning in preoperative or postoperative treatment.
Key Words: Intensity modulated radiation therapy (IMRT), Non-small-cell lung cancer (NSCLC), Radiation pneumonitis, Incidence rate, Prognostic factors
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