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Title

PREDICTIVE FACTORS OF RADIATION-INDUCED LUNG TOXICITY IN LUNG CANCER PATIENTS: A RETROSPECTIVE STUDY

Writers

SOLIMAN MAHER

Pages

 Start Page 137 | End Page 143

Abstract

 Background: Radiation-induced lung TOXICITY is an important dose-limiting TOXICITY in LUNG CANCER RADIOTHERAPY, for which there are no generally accepted predictive factors. This study seeks to identify risk factors associated with the development of severe radiation-induced lung TOXICITY using clinical and dosimetric parameters.Methods: We reviewed the medical records of 54 patients with histologically proven stage III non-small cell LUNG CANCER treated with three dimensional-conformal RADIOTHERAPY at Alexandria Main University Hospital between January 2008 and December 2011. The original treatment plans for those patients were restored and imported to a treatment planning system. Lung DOSE–VOLUME HISTOGRAMs and various dosimetric parameters were calculated. Univariate and multivariate logistic regression analyses were performed.Results: The following grades of radiation-induced lung TOXICITY were observed in patients - grade 0: 17 (31.5%), grade 1: 5 (9.3%), grade 2: 13 (24.1%), grade 3: 15 (27.8%), and grade 5: 4 (7.4%). A total of 19 (35.2%) patients developed grade ≥3 and were considered to have an event. Univariate analysis showed that age, presence of chronic obstructive pulmonary disease and location of the primary tumor had significant associations with severe radiation-induced lung TOXICITY. Other dosimetric variables such as tumor side, histology, forced expiratory volume in 1 s, smoking, and gender showed no significant correlations with severe radiation-induced lung TOXICITY. Multivariate analysis showed that the presence of chronic obstructive pulmonary disease (P=0.001) and location of the primary tumor (P=0.010) were the only predictive factors for severe radiation-induced lung TOXICITY.Conclusion: This study demonstrates that patients with chronic obstructive pulmonary disease and lower lung lobe tumors have a high risk of severe radiationinduced lung TOXICITY when treated with combined chemoradiotherapy. These easily obtained clinical factors should be considered when calculating the risk for radiationinduced lung TOXICITY.

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