| |
著者: David A Palma, Suresh Senan, Kayoko Tsujino, Robert B Barriger, Ramesh Rengan, Marta Moreno, Jeffrey D Bradley, Tae Hyun Kim, Sara Ramella, Lawrence B Marks, Luigi De Petris, Larry Stitt, George Rodrigues
雑誌名: Int J Radiat Oncol Biol Phys. 2013 Feb 1;85(2):444-50. doi: 10.1016/j.ijrobp.2012.04.043. Epub 2012 Jun 9.
Abstract/Text
BACKGROUND: Radiation pneumonitis is a dose-limiting toxicity for patients undergoing concurrent chemoradiation therapy (CCRT) for non-small cell lung cancer (NSCLC). We performed an individual patient data meta-analysis to determine factors predictive of clinically significant pneumonitis.
METHODS AND MATERIALS: After a systematic review of the literature, data were obtained on 836 patients who underwent CCRT in Europe, North America, and Asia. Patients were randomly divided into training and validation sets (two-thirds vs one-third of patients). Factors predictive of symptomatic pneumonitis (grade ≥2 by 1 of several scoring systems) or fatal pneumonitis were evaluated using logistic regression. Recursive partitioning analysis (RPA) was used to define risk groups.
RESULTS: The median radiation therapy dose was 60 Gy, and the median follow-up time was 2.3 years. Most patients received concurrent cisplatin/etoposide (38%) or carboplatin/paclitaxel (26%). The overall rate of symptomatic pneumonitis was 29.8% (n=249), with fatal pneumonitis in 1.9% (n=16). In the training set, factors predictive of symptomatic pneumonitis were lung volume receiving ≥20 Gy (V(20)) (odds ratio [OR] 1.03 per 1% increase, P=.008), and carboplatin/paclitaxel chemotherapy (OR 3.33, P<.001), with a trend for age (OR 1.24 per decade, P=.09); the model remained predictive in the validation set with good discrimination in both datasets (c-statistic >0.65). On RPA, the highest risk of pneumonitis (>50%) was in patients >65 years of age receiving carboplatin/paclitaxel. Predictors of fatal pneumonitis were daily dose >2 Gy, V(20), and lower-lobe tumor location.
CONCLUSIONS: Several treatment-related risk factors predict the development of symptomatic pneumonitis, and elderly patients who undergo CCRT with carboplatin-paclitaxel chemotherapy are at highest risk. Fatal pneumonitis, although uncommon, is related to dosimetric factors and tumor location.
Copyright © 2013 Elsevier Inc. All rights reserved.
PMID 22682812 Int J Radiat Oncol Biol Phys. 2013 Feb 1;85(2):444-50. doi: 10.1016/j.ijrobp.2012.04.043. Epub 2012 Jun 9.
|
