title: Renin-Angiotensin System Inhibitors Might Help to Reduce the Development of Symptomatic Radiation Pneumonitis After Stereotactic Body Radiotherapy for Lung Cancer.
abstract: BACKGROUND
  The purpose of the present study was to evaluate the role of renin-angiotensin system (RAS) inhibitors in preventing symptomatic radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT).
  
  
  METHODS
  The data from 158 patients with a solitary lung lesion treated with 1 to 3 fractions of SBRT from December 2008 to July 2014 were retrospectively analyzed. The incidence of RP was evaluated according to the Common Toxicity Criteria for Adverse Events, version 4. The use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) was analyzed to assess for possible correlations with the development of grade ≥ 2 RP. The patient and dosimetric variables were also assessed.
  
  
  RESULTS
  After a median follow-up period of 13.8 months (range, 3.2-55.0 months), 22 patients had developed grade ≥ 2 RP. Patients with peripheral lesions, favorable dosimetric data, and ACEI and/or ARB use had a reduced risk of symptomatic RP. In unadjusted and adjusted multivariate analyses, ACEI and/or ARB intake and the dosimetric variables were statistically significant factors. In a secondary analysis, the use of ACEIs and ARBs among patients with a greater planning target volume and higher dosimetric values correlated with a reduced risk of symptomatic RP.
  
  
  CONCLUSIONS
  The use of a RAS inhibitor was associated with a decreased incidence of symptomatic RP among patients undergoing SBRT for lung lesions. Patients with higher dosimetric values had a reduced risk of grade ≥ 2 RP with ACEI and ARB use.
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy. Electronic address: stefanobracci@gmail.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bracci
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Valeriani
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Agolli
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Sanctis
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Maurizi Enrici
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Mattia F
authors.initials: MF
authors.lastname: Osti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D017564:Radiation Pneumonitis / Q000453:epidemiology / Q000517:prevention & control*; D016634:Radiosurgery; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin receptors blockers; Angiotensin-converting enzyme inhibitors; Dosimetric factors; Lung SBRT; Radiation pneumonitis