Yoko Tsukita1, Takaya Yamamoto2, Hiroshi Mayahara3, Akito Hata4, Yuichiro Takeda5, Hidetsugu Nakayama6, Satoshi Tanaka7, Junji Uchida7, Kazuhiro Usui8, Tatsuya Toyoda9, Motohiro Tamiya10, Masahiro Morimoto11, Yuko Oya12, Takeshi Kodaira13, Eisaku Miyauchi14, Keiichi Jingu2, Hisatoshi Sugiura14. 1. Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. Electronic address: y-tsukita@rm.med.tohoku.ac.jp. 2. Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. 3. Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan. 4. Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan. 5. Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo 162-8655, Japan. 6. Department of Radiation Oncology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo 162-8655, Japan. 7. Department of Respiratory Medicine, Osaka General Medical Center, 3-1-56, Bandaihigashi, Sumiyoshi-ku, Osaka 558-0056, Japan. 8. Division of Respirology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa, Tokyo 141-8625, Japan. 9. Department of Radiology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa, Tokyo 141-8625, Japan. 10. Department of Thoracic Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka 541-8567, Japan. 11. Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka 541-8567, Japan. 12. Department of Thoracic Oncology, Aichi cancer center hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan. 13. Department of Radiation Oncology, Aichi cancer center hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan. 14. Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Abstract
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.
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 NSCLCpatients 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.