title: Functional and biologic metrics for predicting radiation pneumonitis in locally advanced non-small cell lung cancer patients treated with chemoradiotherapy.
abstract: OBJECTIVE
  To study the predictive value of functional and biologic metrics for predicting radiation pneumonitis (RP) in locally advanced non-small cell lung cancer (LANSCLC) patients treated with chemoradiotherapy.
  
  
  METHODS
  Between March 2006 and April 2010, 57 LANSCLC patients were enrolled in a prospective study. Fusion of SPECT and computed tomography scans provides perfusion-weighted functional dose-volume histogram (DVH) and associated functional dosimetric parameters. Blood for serum biomarkers-interleukin-6 (IL-6), transforming growth factor-beta1, and superoxide dismutase (SOD)-was drawn pre-RT and then 40 Gy/4 weeks during the treatment. The incidence of RP was related to the functional and biologic metrics. The predictability of predictors was calculated and compared based on the area under receiver-operating characteristic (ROC) curve (AUC).
  
  
  RESULTS
  Relative volumes of functional lung receiving more than a threshold dose of 5-50 Gy at increments of 5 Gy and elevated levels of serum SOD after delivery of 40 Gy/4 weeks were associated with RP (p < 0.05). The best predictive efficacy of SOD was observed for a cutoff value of 56 U/ml, with a sensitivity of 0.80 (95 % CI 0.28-0.99) and a specificity of 0.67 (95 % CI 0.43-0.65) (p = 0.040). Functional DVH provided better predictive outcome (AUC 0.76-0.98) than standard DVH (AUC 0.62-0.86) for patients with poor baseline lung function.
  
  
  CONCLUSIONS
  Functional metrics were identified to be better predictors for RP in patients with poor baseline lung function. SOD seemed to be a potential predictor for RP; however, it will need to be further verified using a larger sample size.
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, People's Republic of China.
authors.forename: Dongqing
authors.initials: D
authors.lastname: Wang
authors.forename: Jingyu
authors.initials: J
authors.lastname: Zhu
authors.forename: Jinbo
authors.initials: J
authors.lastname: Sun
authors.forename: Baosheng
authors.initials: B
authors.lastname: Li
authors.forename: Zhongtang
authors.initials: Z
authors.lastname: Wang
authors.forename: Ling
authors.initials: L
authors.lastname: Wei
authors.forename: Yong
authors.initials: Y
authors.lastname: Yin
authors.forename: Hongfu
authors.initials: H
authors.lastname: Sun
authors.forename: Zheng
authors.initials: Z
authors.lastname: Fu
authors.forename: Xingguo
authors.initials: X
authors.lastname: Zhang
authors.forename: Zongwei
authors.initials: Z
authors.lastname: Huo
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008168:Lung / Q000473:pathology / Q000503:physiopathology; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D017564:Radiation Pneumonitis / Q000209:etiology* / Q000503:physiopathology; D013482:Superoxide Dismutase / Q000097:blood; D053773:Transforming Growth Factor beta1 / Q000097:blood
chemical_list: D015850:Interleukin-6; D053773:Transforming Growth Factor beta1; D013482:Superoxide Dismutase