Takashi Shintani1, Noriko Kishi2, Yukinori Matsuo3, Masakazu Ogura4, Takamasa Mitsuyoshi5, Norio Araki6, Kota Fujii7, Setsuko Okumura8, Kiyoshi Nakamatsu9, Takahiro Kishi10, Tomoko Atsuta11, Takashi Sakamoto12, Masaru Narabayashi13, Yuichi Ishida14, Masato Sakamoto15, Satsuki Fujishiro16, Tomohiro Katagiri17, Young Hak Kim18, Takashi Mizowaki2. 1. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, Japan. 2. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 3. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: ymatsuo@kuhp.kyoto-u.ac.jp. 4. Department of Radiation Oncology, Kishiwada City Hospital, Kishiwada, Japan. 5. Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan. 6. Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 7. Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, Japan. 8. Department of Radiation Oncology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan. 9. Department of Radiation Oncology, Kindai University Faculty of Medicine, Osakasayama, Japan. 10. Department of Radiation Oncology, Osaka Red Cross Hospital, Osaka, Japan. 11. Department of Radiology, Tazuke Kofukai, Medical Research Institute, Osaka, Japan. 12. Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan. 13. Department of Radiation Oncology, Kyoto City Hospital, Kyoto, Japan. 14. Department of Radiation Oncology, Tenri Hospital, Tenri, Japan. 15. Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, Japan. 16. Department of Radiation Oncology, Shinko Hospital, Kobe, Japan. 17. Department of Radiation Oncology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan. 18. Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
INTRODUCTION: Data on the risk factors for symptomatic radiation pneumonitis (RP) in non-small-cell lung cancer (NSCLC) patients treated with concurrent chemoradiotherapy (CCRT) and consolidation durvalumab are limited; we aimed to investigate these risk factors. MATERIALS AND METHODS: This multicenter retrospective study, conducted at 15 institutions in Japan, included patients who were ≥20 years of age; who started definitive CCRT for NSCLC between July 1, 2018, and July 31, 2019; and who then received durvalumab. The primary endpoint was grade 2 or worse (grade 2+) RP. RESULTS: In the 146 patients analyzed, the median follow-up period was 16 months. A majority of the patients had stage III disease (86%), received radiation doses of 60 to 66 Gy equivalent in 2-Gy fractions (93%) and carboplatin and paclitaxel/nab-paclitaxel (77%), and underwent elective nodal irradiation (71%) and 3-dimensional conformal radiotherapy (75%). RP grade 2 was observed in 44 patients (30%); grade 3, in four patients (3%); grade 4, in one patient (1%); and grade 5, in one patient (1%). In the multivariable analysis, lung V20 was a significant risk factor, whereas age, sex, smoking history, irradiation technique, and chemotherapy regimen were not. The 12-month grade 2+ RP incidence was 34.4% (95% confidence interval [CI], 26.7%-42.1%); the values were 50.0% (95% CI, 34.7%-63.5%) and 27.1% (95% CI, 18.8%-36.2%) in those with lung V20 ≥ 26% and < 26%, respectively (P = .007). CONCLUSION: The incidence of grade 2+ RP was relatively high in this multicenter real-world study, and its risk increased remarkably at elevated lung V20. Our findings can aid in RP risk prediction and the safe radiotherapy treatment planning.
INTRODUCTION: Data on the risk factors for symptomatic radiation pneumonitis (RP) in non-small-cell lung cancer (NSCLC) patients treated with concurrent chemoradiotherapy (CCRT) and consolidation durvalumab are limited; we aimed to investigate these risk factors. MATERIALS AND METHODS: This multicenter retrospective study, conducted at 15 institutions in Japan, included patients who were ≥20 years of age; who started definitive CCRT for NSCLC between July 1, 2018, and July 31, 2019; and who then received durvalumab. The primary endpoint was grade 2 or worse (grade 2+) RP. RESULTS: In the 146 patients analyzed, the median follow-up period was 16 months. A majority of the patients had stage III disease (86%), received radiation doses of 60 to 66 Gy equivalent in 2-Gy fractions (93%) and carboplatin and paclitaxel/nab-paclitaxel (77%), and underwent elective nodal irradiation (71%) and 3-dimensional conformal radiotherapy (75%). RP grade 2 was observed in 44 patients (30%); grade 3, in four patients (3%); grade 4, in one patient (1%); and grade 5, in one patient (1%). In the multivariable analysis, lung V20 was a significant risk factor, whereas age, sex, smoking history, irradiation technique, and chemotherapy regimen were not. The 12-month grade 2+ RP incidence was 34.4% (95% confidence interval [CI], 26.7%-42.1%); the values were 50.0% (95% CI, 34.7%-63.5%) and 27.1% (95% CI, 18.8%-36.2%) in those with lung V20 ≥ 26% and < 26%, respectively (P = .007). CONCLUSION: The incidence of grade 2+ RP was relatively high in this multicenter real-world study, and its risk increased remarkably at elevated lung V20. Our findings can aid in RP risk prediction and the safe radiotherapy treatment planning.