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Japanese Journal of Clinical Oncology Advance Access published online on February 3, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyn158
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© The Author (2009). Published by Oxford University Press. All rights reserved

Prediction of Radiation Pneumonitis Following High-dose Thoracic Radiation Therapy by 3 Gy/fraction for Non-small Cell Lung Cancer: Analysis of Clinical and Dosimetric Factors

Dongryul Oh, Yong Chan Ahn, Hee Chul Park, Do Hoon Lim and Youngyih Han

Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

For reprints and all correspondence: Yong Chan Ahn, Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea. E-mail: ahnyc{at}skku.edu, ycahn.ahn{at}samsung.com; Hee Chul Park, Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea. E-mail: rophc{at}skku.edu, hee.ro.park{at}samsung.com

Received October 5, 2008; accepted December 18, 2008

Objective: This study was undertaken to identify the factors predictive of radiation pneumonitis (RP) in 69 non-small cell lung cancer patients treated with thoracic radiation therapy only by 3 Gy fractions.

Methods: A total of 69 patients who received only RT in daily 3 Gy were included in this study. Grade ≥3 RP was defined as an RP event. The cumulative incidence of RP was estimated and the correlations of the development of RP with the potential predictors were determined.

Results: The cumulative incidence of events was 17.1% at 12 months. By univariate analysis, all clinical factors [age, performance status, weight loss, pre-RT forced expiratory volume in 1 s, tumour location, stage, RT dose and clinical target volume] were not associated with the risk of Grade ≥3 RP; however, all dosimetric factors [V5–50 and mean lung dose (MLD)] closely correlated with the development of RP. The receiver-operative characteristics (ROC) analysis revealed that MLD was the best predictors of Grade ≥3 RP (area under curve ROC = 0.937). By multivariate analysis, MLD was the only significant factor to be predictive of RP risk: the probability of Grade ≥3 RP was 3.7% when MLD ≤ 16.1 Gy and 78.4% when MLD > 16.1 Gy.

Conclusions: Dosimetric parameters were valuable in predicting the development of RP.

Key Words: radiation pneumonitis • radiation therapy • hypofractionated treatment • lung cancer


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