title: Can exhaled NO fraction predict radiotherapy-induced lung toxicity in lung cancer patients?
abstract: BACKGROUND
  A large increase in nitric oxide fraction (FeNO) after radiotherapy (RT) for lung cancer may predict RT-induced lung toxicity.
  
  
  METHODS
  In this study, we assessed the relationships between FeNO variations and respiratory symptoms, CT scan changes or dose volume histogram (DVH) parameters after RT. We measured FeNO before RT, 4, 5, 6, 10 weeks, 4 and 7.5 months after RT in 65 lung cancer patients.
  
  
  RESULTS
  Eleven lung cancer patients (17%) complained of significant respiratory symptoms and 21 (31%) had radiation pneumonitis images in > 1/3 of the irradiated lung after RT. Thirteen patients (20%) showed increases in FeNO > 10 ppb. The sensitivity and specificity of a > 10 ppb FeNO increase for the diagnosis of RT-associated respiratory symptoms were 18% and 83%, respectively. There was no correlation between DVH parameters or CT scan changes after RT and FeNO variations. Three patients (5%) showed intriguingly strong (2 or 3-fold, up to 55 ppb) and sustained increases in FeNO at 4 and 5 weeks, followed by significant respiratory symptoms and/or radiation-pneumonitis images.
  
  
  CONCLUSIONS
  Serial FeNO measurements during RT had a low ability to identify lung cancer patients who developed symptoms or images of radiation pneumonitis. However, three patients presented with a particular pattern which deserves to be investigated.
authors: Pôle de Pathologie Thoracique, Hôpitaux Universitaires, BP 426, 67091 Strasbourg Cedex, France.
authors: Irina
authors: I
authors: Enache
authors: Georges
authors: G
authors: Noel
authors: M Young
authors: MY
authors: Jeung
authors: Nicolas
authors: N
authors: Meyer
authors: Monique
authors: M
authors: Oswald-Mammosser
authors: Emile
authors: E
authors: Urban-Kraemer
authors: Catherine
authors: C
authors: Schumacher
authors: Bernard
authors: B
authors: Geny
authors: Elisabeth
authors: E
authors: Quoix
authors: Anne
authors: A
authors: Charloux
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D001944:Breath Tests; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000378:metabolism / Q000528:radiation effects*; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D017564:Radiation Pneumonitis / Q000175:diagnosis*; D011879:Radiotherapy Dosage; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones; D009569:Nitric Oxide