title: Poor baseline pulmonary function may not increase the risk of radiation-induced lung toxicity.
abstract: OBJECTIVE
  Poor pulmonary function (PF) is often considered a contraindication to definitive radiation therapy for lung cancer. This study investigated whether baseline PF was associated with radiation-induced lung toxicity (RILT) in patients with non-small cell lung cancer (NSCLC) receiving conformal radiation therapy (CRT).
  
  
  METHODS
  NSCLC patients treated with CRT and tested for PF at baseline were eligible. Baseline predicted values of forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), and diffusion capacity of lung for carbon monoxide (DLCO) were analyzed. Additional factors included age, gender, smoking status, Karnofsky performance status, coexisting chronic obstructive pulmonary disease (COPD), tumor location, histology, concurrent chemotherapy, radiation dose, and mean lung dose (MLD) were evaluated for RILT. The primary endpoint was symptomatic RILT (SRILT), including grade ≥2 radiation pneumonitis and fibrosis.
  
  
  RESULTS
  There was a total of 260 patients, and SRILT occurred in 58 (22.3%) of them. Mean FEV1 values for SRILT and non-SRILT patients were 71.7% and 65.9% (P=.077). Under univariate analysis, risk of SRILT increased with MLD (P=.008), the absence of COPD (P=.047), and FEV1 (P=.077). Age (65 split) and MLD were significantly associated with SRILT in multivariate analysis. The addition of FEV1 and age with the MLD-based model slightly improved the predictability of SRILT (area under curve from 0.63-0.70, P=.088).
  
  
  CONCLUSIONS
  Poor baseline PF does not increase the risk of SRILT, and combining FEV1, age, and MLD may improve the predictive ability.
authors: Department of Radiation Oncology, University of Michigan/Ann Arbor Veterans Health System, Ann Arbor, Michigan, USA.
authors: Jingbo
authors: J
authors: Wang
authors: Jianzhong
authors: J
authors: Cao
authors: Shuanghu
authors: S
authors: Yuan
authors: Wei
authors: W
authors: Ji
authors: Douglas
authors: D
authors: Arenberg
authors: Jianrong
authors: J
authors: Dai
authors: Paul
authors: P
authors: Stanton
authors: Daniel
authors: D
authors: Tatro
authors: Randall K
authors: RK
authors: Ten Haken
authors: Luhua
authors: L
authors: Wang
authors: Feng-Ming Spring
authors: FM
authors: Kong
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019540:Area Under Curve; D002245:Carbon Dioxide / Q000378:metabolism; D002289:Carcinoma, Non-Small-Cell Lung / Q000503:physiopathology / Q000532:radiotherapy*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008168:Lung / Q000503:physiopathology / Q000528:radiation effects*; D008175:Lung Neoplasms / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011653:Pulmonary Diffusing Capacity / Q000502:physiology; D017564:Radiation Pneumonitis / Q000209:etiology*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D012129:Respiratory Function Tests; D012737:Sex Factors; D014797:Vital Capacity / Q000502:physiology
chemical_list: D002245:Carbon Dioxide