title: Acute radiation pneumonitis after conformational radiotherapy for nonsmall cell lung cancer: clinical, dosimetric, and associated-treatment risk factors.
abstract: BACKGROUND
  Conformational thoracic radiotherapy (CTR) is a key-treatment in locally advanced nonsmall cell lung cancer (LA-NSCLC). Acute radiation pneumonitis (ARP) is one of the major complications.
  
  
  OBJECTIVE
  To evaluate the predictors of ARP after CTR in the treatment of LA-NSCLC.
  
  
  METHODS
  A total of 47 consecutive patients (pts) were treated with CTR for LA-NSCLC and retrospectively analyzed. The mean total dose of radiation therapy (RT) was 65 Gy, with respiratory gating (RG) in 19 cases. Induction and concomitant chemotherapy was performed in 33 pts (70%) and 41 pts (87%), respectively.
  
  
  RESULTS
  Eleven pts (23%) had an ARP resulting in death for one pt. In univariate analysis, age, sex, pretherapeutic value of forced expiratory volume (FEV), not-gated radiotherapy and type of concomitant chemotherapy did not appear as contributing factors in contrast to the administration of induction gemcitabine ( p = 0.03). The occurrence of ARP was significantly associated with nontumor lung volumes irradiated to 13 Gy (V13, p = 0.04), 20 Gy (V20, p = 0.02), and 25 Gy (V25, p = 0.006), the mean lung dose ( p = 0.008) and lung normal tissue complication probability (NTCP) ( p = 0.004). In multivariate logistic regression analysis, the occurrence of ARP was significantly associated with age >75 years (odds ratio (OR) = 16.72, confidence interval (CI) 95% 1.77-157.87) and administration of induction gemcitabine (OR = 18.08, CI 95% 1.09-300.08).
  
  
  CONCLUSIONS
  ARP is a common acute complication, requiring close posttreatment follow-up, particularly for elderly patients. The use of gemcitabine before radiation should be avoided. The benefits and risks of CTR must be carefully analyzed, according to the dosimetric parameters.
authors.affiliation: Department of Respiratory Diseases, Hôpital Ambroise Paré, 9 Avenue Charles-de-Gaulle 92100 Boulogne-Billancourt; University Versailles-Saint Quentin en Yvelines, 9 Boulevard d'Alembert, 78280 Guyancourt, France.
authors.forename: Etienne Giroux
authors.initials: EG
authors.lastname: Leprieur
authors.forename: Diego
authors.initials: D
authors.lastname: Fernandez
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.forename: Sylvain
authors.initials: S
authors.lastname: Klotz
authors.forename: Philippe
authors.initials: P
authors.lastname: Giraud
authors.forename: Catherine
authors.initials: C
authors.lastname: Durdux
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D017564:Radiation Pneumonitis / Q000175:diagnosis*; D011874:Radiometry; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors