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Article: Radiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-TKIs: is there any difference from stereotactic body radiotherapy alone?

TitleRadiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-TKIs: is there any difference from stereotactic body radiotherapy alone?
Authors
KeywordsEpidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs)
stereotactic body radiotherapy (SBRT)
quantitative CT analysis
normal tissue complication probability (NTCP)
lung damage
Issue Date2021
PublisherAME Publishing Company. The Journal's web site is located at http://apm.amegroups.com/
Citation
Annals of Palliative Medicine, 2021, v. 10 n. 3, p. 2832-2842 How to Cite?
AbstractBackground: 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.
Persistent Identifierhttp://hdl.handle.net/10722/301943
ISSN
2020 Impact Factor: 2.595
2020 SCImago Journal Rankings: 0.546

 

DC FieldValueLanguage
dc.contributor.authorTang, X-
dc.contributor.authorShen, Y-
dc.contributor.authorMeng, Y-
dc.contributor.authorHou, L-
dc.contributor.authorZhou, C-
dc.contributor.authorYu, C-
dc.contributor.authorJia, H-
dc.contributor.authorWang, W-
dc.contributor.authorRen, G-
dc.contributor.authorCai, J-
dc.contributor.authorLi, XA-
dc.contributor.authorYang, H-
dc.contributor.authorKong, FP-
dc.date.accessioned2021-08-21T03:29:15Z-
dc.date.available2021-08-21T03:29:15Z-
dc.date.issued2021-
dc.identifier.citationAnnals of Palliative Medicine, 2021, v. 10 n. 3, p. 2832-2842-
dc.identifier.issn2224-5820-
dc.identifier.urihttp://hdl.handle.net/10722/301943-
dc.description.abstractBackground: 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.-
dc.languageeng-
dc.publisherAME Publishing Company. The Journal's web site is located at http://apm.amegroups.com/-
dc.relation.ispartofAnnals of Palliative Medicine-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectEpidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs)-
dc.subjectstereotactic body radiotherapy (SBRT)-
dc.subjectquantitative CT analysis-
dc.subjectnormal tissue complication probability (NTCP)-
dc.subjectlung damage-
dc.titleRadiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-TKIs: is there any difference from stereotactic body radiotherapy alone?-
dc.typeArticle-
dc.identifier.emailKong, FP: kong0001@hku.hk-
dc.identifier.authorityKong, FP=rp02508-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.21037/apm-20-1116-
dc.identifier.pmid33548998-
dc.identifier.scopuseid_2-s2.0-85103339079-
dc.identifier.hkuros324247-
dc.identifier.volume10-
dc.identifier.issue3-
dc.identifier.spage2832-
dc.identifier.epage2842-
dc.publisher.placeHong Kong-

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