title: Pulmonary damage in Hodgkin's lymphoma patients treated with sequential chemo-radiotherapy: Predictors of radiation-induced lung injury.
abstract: BACKGROUND
  Our aim was to define predictors of late radiation-induced lung injury (RILI) in Hodgkin's lymphoma (HL) survivors treated with bleomycin-containing chemotherapy and radiotherapy.
  
  
  METHODS
  Eighty consecutive patients treated with chemotherapy and subsequent supradiaphragmatic radiation therapy for HL were retrospectively reviewed for symptoms and/or radiological signs of RILI. Median patient age was 26 years (range 14-55). Left, right, and total lung dosimetric parameters along with clinical, disease, and treatment-related characteristics were analyzed. Multivariate logistic regression analyses were performed. A receiver operator characteristic (ROC) curve analysis was performed to find possible cutoff values dividing patients into high- and low-risk groups.
  
  
  RESULTS
  Seven of 80 (9%) patients had lung disease at baseline. Four of 80 (5%) had toxicity after chemotherapy and before the beginning of radiotherapy. These patients were excluded from further evaluation. At a median time of 10 months (range 9-18), 9/69 patients (13%) developed lung radiological changes on computed tomography (CT) after treatment. Four of nine patients were diagnosed RTOG grade ≥ 2. On multivariate analyses, left-lung V30 (p = 0.004, OR = 1.108 95% CI 1.033-1.189) and total-lung V30 (p = 0.009, OR = 1.146 95% CI 1.035-1.270) resulted to be predictors of lung CT changes with a cutoff value of 16% and 15%, respectively. When only symptomatic RILI was considered a left-lung V30 cutoff value of 32% was estimated.
  
  
  CONCLUSIONS
  Bleomycin and RT may cause lung injury in a small, but significant fraction of HL patients. Left-lung V30 predicts the risk of developing asymptomatic or symptomatic RILI after sequential chemo-radiotherapy.
authors.affiliation: Institute of Biostructures and Bioimaging, National Council of Research (CNR) , Naples , Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cella
authors.forename: Raffaele
authors.initials: R
authors.lastname: Liuzzi
authors.forename: Vittoria
authors.initials: V
authors.lastname: D'Avino
authors.forename: Manuel
authors.initials: M
authors.lastname: Conson
authors.forename: Angela
authors.initials: A
authors.lastname: Di Biase
authors.forename: Marco
authors.initials: M
authors.lastname: Picardi
authors.forename: Novella
authors.initials: N
authors.lastname: Pugliese
authors.forename: Raffaele
authors.initials: R
authors.lastname: Solla
authors.forename: Marco
authors.initials: M
authors.lastname: Salvatore
authors.forename: Roberto
authors.initials: R
authors.lastname: Pacelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D019540:Area Under Curve; D001761:Bleomycin / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D015994:Incidence; D055370:Lung Injury / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012372:ROC Curve; D017564:Radiation Pneumonitis / Q000453:epidemiology*; D012189:Retrospective Studies; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D005047:Etoposide; D003606:Dacarbazine; D004317:Doxorubicin; D011241:Prednisone