title: Risk factors associated with fatal pulmonary hemorrhage in locally advanced non-small cell lung cancer treated with chemoradiotherapy.
abstract: BACKGROUND
  The purpose of this study was to identify the risk factors associated with fatal pulmonary hemorrhage (PH) in patients with locally advanced non-small cell lung cancer (NSCLC), treated with chemoradiotherapy.
  
  
  METHODS
  The medical records of 583 patients with locally advanced NSCLC, who were treated with chemoradiotherapy between July 1992 and December 2009 were reviewed. Fatal PH was defined as PH leading to death within 24 h of its onset. Tumor cavitation size was defined by the cavitation diameter/tumor diameter ratio and was classified as minimum (< 0.25), minor (≥ 0.25, but < 0.5), and major (≥ 0.5).
  
  
  RESULTS
  Of the 583 patients, 2.1% suffered a fatal PH. The numbers of patients with minimum, minor, and major cavitations were 13, 11, and 14, respectively. Among the 38 patients with tumor cavitation, all 3 patients who developed fatal PH had major cavitations. On multivariate analysis, the presence of baseline major cavitation (odds ratio, 17.878), and a squamous cell histology (odds ratio, 5.491) proved to be independent significant risk factors for fatal PH. Interestingly, all patients with fatal PH and baseline major cavitation were found to have tumors with squamous cell histology, and the occurrence of fatal PH in patients having both risk factors was 33.3%.
  
  
  CONCLUSIONS
  Patients at high risk of fatal PH could be identified using a combination of independent risk factors.
authors.affiliation: Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Ito
authors.forename: Seiji
authors.initials: S
authors.lastname: Niho
authors.forename: Keiji
authors.initials: K
authors.lastname: Nihei
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Yoh
authors.forename: Hironobu
authors.initials: H
authors.lastname: Ohmatsu
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ohe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000453:epidemiology / Q000209:etiology*; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors