Effects of radiotherapy and chemotherapy on lung function in patients with non-small-cell lung cancer.
OBJECTIVE
To evaluate the effects of chemoradiation on objective tests of pulmonary function.


METHODS
One hundred lung cancer patients treated in five protocols between 1992 and 2000 with combinations of thoracic radiotherapy (RT) and chemotherapy were evaluated with pre- and post-RT pulmonary function tests. The pulmonary function tests were analyzed for changes in measures of obstruction (forced expiratory volume in 1 s per unit of vital capacity [FEV(1)/VC]), restriction (total lung capacity [TLC]), and diffusing capacity (diffusing capacity for carbon monoxide [DLCO]). The use and timing of chemotherapy and RT, as well as patient, tumor, and treatment factors, were evaluated using univariate and multivariate analyses.


RESULTS
No treatment or patient factors were significantly associated with changes in FEV(1)/VC. Chemotherapy with RT, compared with RT alone, was associated with a lower post-RT TLC (92% vs. 107%, p = 0.002). Nodal status (N2-N3 vs. N1), tumor location (central vs. peripheral), use of >/=6 treatment fields, and tumor volume >/=100 cm(3) were also associated with a significantly lower post-RT TLC. On univariate analysis, the use of any chemotherapy (p = 0.029) and the use of concurrent vs. sequential chemotherapy (p = 0.028) were predictive of a lower post-RT DLCO. Patient age >/=60 years, nodal status (N2-N3 vs. N0-N1), tumor volume >/=100 cm(3), tumor location (central vs. peripheral), and use of >/=6 treatment fields were also associated with a significantly lower post-RT DLCO. The fractional volume of irradiated normal lung correlated with the decrease in DLCO (p <0.001), with a 1.3% DLCO decline for each 1% of total lung volume that received >20 Gy.


CONCLUSIONS
The addition of chemotherapy to RT significantly exacerbates the post-RT decrease in TLC and DLCO. The greatest decrease in DLCO occurs in patients treated with concurrent chemoradiation.
Gopal
Ramesh
R
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Starkschall
George
G
Tucker
Susan L
SL
Cox
James D
JD
Liao
Zhongxing
Z
Hanus
Michael
M
Kelly
Jason F
JF
Stevens
Craig W
CW
Komaki
Ritsuko
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology* / Q000627:therapeutic use; D002245:Carbon Dioxide / Q000378:metabolism; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000494:pharmacology; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000503:physiopathology / Q000528:radiation effects*; D008175:Lung Neoplasms / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011653:Pulmonary Diffusing Capacity; D011867:Radioisotope Teletherapy / Q000009:adverse effects*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D014109:Total Lung Capacity; D014747:Vinblastine / Q000008:administration & dosage / Q000494:pharmacology
D002245:Carbon Dioxide; D014747:Vinblastine; D005047:Etoposide; D002945:Cisplatin