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著者: Yoko Tsukita, Takaya Yamamoto, Hiroshi Mayahara, Akito Hata, Yuichiro Takeda, Hidetsugu Nakayama, Satoshi Tanaka, Junji Uchida, Kazuhiro Usui, Tatsuya Toyoda, Motohiro Tamiya, Masahiro Morimoto, Yuko Oya, Takeshi Kodaira, Eisaku Miyauchi, Keiichi Jingu, Hisatoshi Sugiura
雑誌名: Radiother Oncol. 2021 Jul;160:266-272. doi: 10.1016/j.radonc.2021.05.016. Epub 2021 May 21.
Abstract/Text
BACKGROUND AND PURPOSE: Intensity-modulated radiation therapy (IMRT) is increasingly applied in concurrent chemoradiotherapy (CCRT) for locally-advanced non-small cell lung cancer (NSCLC), with improvement of target coverage and better sparing of normal tissue. IMRT tends to have a larger low-dose irradiation volume than 3D conformal radiotherapy, but the incidence of and risk factors for pneumonitis remain unclear, especially following the approval of durvalumab.
MATERIALS AND METHODS: We retrospectively reviewed the records of NSCLC patients treated by CCRT using IMRT at seven Japanese institutions. Primary outcomes were incidence of symptomatic pneumonitis and progression-free survival (PFS). Multivariate logistic regression analysis was used to identify risk factors for ≥grade 2 pneumonitis.
RESULTS: Median follow-up from the start of CCRT was 14.3 months (n = 107 patients; median age 70 years, 29% female). Median lung V5 and V20 was 49.2% and 19.5%, respectively. Durvalumab was administered to 87 patients (81%). Pneumonitis developed in 95 (89%) patients of which 53% had grade 1, 28% grade 2, 6.5% grade 3, and 0.9% grade 4. Durvalumab had been discontinued in 16 patients (18.4%) due to pneumonitis. By multivariate analysis, age ≥70 years, male sex, and V5 ≥58.9% were identified as significantly associated with ≥grade 2 pneumonitis (p = 0.0065, 0.036 and 0.0013 respectively). The median PFS from the start of CCRT was not reached (95% CI, 14.2 months to not reached) in patients receiving durvalumab.
CONCLUSION: CCRT using IMRT followed by durvalumab was generally effective and tolerable; V5 <60% would be recommended to avoid symptomatic pneumonitis.
Copyright © 2021 Elsevier B.V. All rights reserved.
PMID 34023330 Radiother Oncol. 2021 Jul;160:266-272. doi: 10.1016/j.radonc.2021.05.016. Epub 2021 May 21.
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