Impact of pretreatment interstitial lung disease on radiation pneumonitis and survival after stereotactic body radiation therapy for lung cancer

Nami Ueki, Yukinori Matsuo, Yosuke Togashi, Takeshi Kubo, Keiko Shibuya, Yusuke Iizuka, Takashi Mizowaki, Kaori Togashi, Michiaki Mishima, Masahiro Hiraoka

Research output: Contribution to journalArticlepeer-review

103 Citations (Scopus)

Abstract

Introduction: To investigate the impact of pre-existing radiological interstitial lung disease (ILD) findings on the incidence of radiation pneumonitis (RP) and clinical outcomes after stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer. Methods: We included 157 consecutive patients who underwent SBRT alone for stage I non-small-cell lung cancer and whose pretreatment lung computed tomography images were available for retrospective review. The pretreatment computed tomography images were evaluated retrospectively for the presence of ILD. The incidence of RP, overall survival (OS) rate, and the incidence of disease progression and local progression were evaluated between patients with ILD (ILD[+]) and without ILD (ILD[-]). Results: Pre-existing ILD was identified in 20 patients. The median follow-up period was 39.5 months. The incidences of RP worse than grade 2 (≥ Gr2 RP) and worse than grade 3 (≥ Gr3 RP) were significantly higher in ILD(+) than ILD(-) (1 year ≥ Gr2 RP rate, 55.0% versus 13.3%; p < 0.001 and 1year ≥ Gr3 RP rate 10.0% versus 1.5%; p = 0.020). Multivariate analysis also indicated that ILD(+) was a risk factor for ≥ Gr2 and ≥ Gr3 RP, and the volume of the irradiated lung. The OS rate tended to be worse in ILD(+) than ILD(-) (3-year OS, 53.8% versus 70.8%; p = 0.28). No difference was observed in the disease progression or local progression rates. Conclusions: Pre-existing ILD was a significant risk factor for symptomatic and severe RP. Prescreening for ILD findings is important for determining the radiation pneumonitis risk when planning SBRT.

Original languageEnglish
Pages (from-to)116-125
Number of pages10
JournalJournal of Thoracic Oncology
Volume10
Issue number1
DOIs
Publication statusPublished - Jan 1 2015
Externally publishedYes

Keywords

  • Interstitial lung disease
  • Lung cancer
  • Radiation pneumonitis
  • Stereotactic body radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

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