title: Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-Hodgkin lymphoma.
abstract: OBJECTIVE
  Few studies to date have evaluated factors associated with the development of radiation pneumonitis (RP) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), especially in patients treated with contemporary radiation techniques. These patients represent a unique group owing to the often large radiation target volumes within the mediastinum and to the potential to receive several lines of chemotherapy that add to pulmonary toxicity for relapsed or refractory disease. Our objective was to determine the incidence and clinical and dosimetric risk factors associated with RP in lymphoma patients treated with intensity modulated radiation therapy (IMRT) at a single institution.
  
  
  METHODS
  We retrospectively reviewed clinical charts and radiation records of 150 consecutive patients who received mediastinal IMRT for HL and NHL from 2009 through 2013. Clinical and dosimetric predictors associated with RP according to Radiation Therapy Oncology Group (RTOG) acute toxicity criteria were identified in univariate analysis using the Pearson χ(2) test and logistic multivariate regression.
  
  
  RESULTS
  Mediastinal radiation was administered as consolidation therapy in 110 patients with newly diagnosed HL or NHL and in 40 patients with relapsed or refractory disease. The overall incidence of RP (RTOG grades 1-3) was 14% in the entire cohort. Risk of RP was increased for patients who received radiation for relapsed or refractory disease (25%) versus those who received consolidation therapy (10%, P=.019). Several dosimetric parameters predicted RP, including mean lung dose of >13.5 Gy, V20 of >30%, V15 of >35%, V10 of >40%, and V5 of >55%. The likelihood ratio χ(2) value was highest for V5 >55% (χ(2) = 19.37).
  
  
  CONCLUSIONS
  In using IMRT to treat mediastinal lymphoma, all dosimetric parameters predicted RP, although small doses to large volumes of lung had the greatest influence. Patients with relapsed or refractory lymphoma who received salvage chemotherapy and hematopoietic stem cell transplantation were at higher risk for symptomatic RP.
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: ccpinnix@mdanderson.org.
authors: Chelsea C
authors: CC
authors: Pinnix
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Grace L
authors: GL
authors: Smith
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Sarah
authors: S
authors: Milgrom
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Eleanor M
authors: EM
authors: Osborne
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Jay P
authors: JP
authors: Reddy
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Mani
authors: M
authors: Akhtari
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Valerie
authors: V
authors: Reed
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Isidora
authors: I
authors: Arzu
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Pamela K
authors: PK
authors: Allen
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Christine F
authors: CF
authors: Wogan
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Michele A
authors: MA
authors: Fanale
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Yasuhiro
authors: Y
authors: Oki
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Francesco
authors: F
authors: Turturro
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Jorge
authors: J
authors: Romaguera
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Luis
authors: L
authors: Fayad
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Nathan
authors: N
authors: Fowler
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Jason
authors: J
authors: Westin
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Loretta
authors: L
authors: Nastoupil
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Fredrick B
authors: FB
authors: Hagemeister
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: M Alma
authors: MA
authors: Rodriguez
authors: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Sairah
authors: S
authors: Ahmed
authors: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Yago
authors: Y
authors: Nieto
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Bouthaina
authors: B
authors: Dabaja
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000627:therapeutic use; D003606:Dacarbazine / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006689:Hodgkin Disease / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008168:Lung / Q000528:radiation effects*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000532:radiotherapy*; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D008875:Middle Aged; D017564:Radiation Pneumonitis / Q000209:etiology*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012044:Regression Analysis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D014747:Vinblastine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin