title: Inhalative steroids as an individual treatment in symptomatic lung cancer patients with radiation pneumonitis grade II after radiotherapy - a single-centre experience.
abstract: OBJECTIVE
  To assess efficacy of our single-centre experience with inhalative steroids (IS) in lung cancer patients with symptomatic radiation pneumonitis (RP) grade II.
  
  
  METHODS
  Between 05/09 and 07/10, 24 patients (female, n = 8; male, n = 16) with lung cancer (non-small cell lung carcinoma [NSCLC]: n = 19; small cell lung cancer [SCLC]: n = 3; unknown histology: n = 2) and good performance status (ECOG ≤1) received definitive radiotherapy to the primary tumour site and involved lymph nodes with concurrent chemotherapy (n = 18), sequential chemotherapy (n = 2) or radiation only (n = 4) and developed symptomatic RP grade II during follow-up. No patient presented with oxygen requiring RP grade III. The mean age at diagnosis was 66 years (range: 50-82 years). Nine patients suffered from chronic obstructive pulmonary disease (COPD) before treatment, and 18 patients had a smoking history (median pack years: 48). The mean lung dose was 15.5 Gy (range: 3.0-23.1 Gy). All patients were treated with IS. If a patient's clinical symptoms did not significantly improve within two weeks of IS therapy initiation, their treatment was switched to oral prednisolone.
  
  
  RESULTS
  All 24 patients were initially treated with a high dose IS (budesonide 800 μg 1-0-1) for 14 days. Of the patients, 18 showed a significant improvement of clinical symptoms and 6 patients did not show significant improvement of clinical symptoms and were classified as non-responders to IS. Their treatment was switched to oral steroids after two weeks (starting with oral prednisolone, 0.5 mg/kg bodyweight; at least 50 mg per day). All of these patients responded to the prednisolone. None of non-responders presented with increased symptoms of RP and required oxygen and / or hospitalization (RP grade III). The median follow-up after IS treatment initiation was 18 months (range: 4-66 months). The median duration of IS treatment and prednisolone treatment was 8.2 months (range: 3.0-48.3 months) and 11.4 months (range: 5.0-44.0 months), respectively. Of the 18 IS treatment responders, 2 (11.1 %) patients with pre-existing grade 2 COPD still required IS (400 μg twice a day) 45.0 and 48.3 months after radiotherapy, respectively. For the remaining 16 responders (88.9 %), IS therapy was stopped after 7.7 months (range: 3.0-18.2 months). None of the patients treated with IS developed any specific IS-related side effects such as oral candidiasis.
  
  
  CONCLUSIONS
  This single-centre experience shows that high-dose IS is an individual treatment option for radiation-induced pneumonitis grade II in patients with a good performance status.
authors.affiliation: Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. henkenberens.christoph@mh-hannover.de.|Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. henkenberens.christoph@mh-hannover.de.
authors.forename: C
authors.initials: C
authors.lastname: Henkenberens
authors.affiliation: Hannover Joint Practice in Radiooncology, Rundestr. 10, 30161, Hannover, Germany. st-janssen@gmx.net.|Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. st-janssen@gmx.net.
authors.forename: S
authors.initials: S
authors.lastname: Janssen
authors.affiliation: Ibbenbüren Hospital Thoracic and Lung Center, Große Str. 41, 49477, Ibbenbüren, Germany. m.lavae-mokthari@mathias-spital.de.
authors.forename: M
authors.initials: M
authors.lastname: Lavae-Mokhtari
authors.affiliation: Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. leni.katharina@mh-hannover.de.
authors.forename: K
authors.initials: K
authors.lastname: Leni
authors.affiliation: Hildesheim Goslar Joint Practice in Radiooncology, Senator-Braun-Allee, 31135, Hildesheim, Germany. ameyer@strahlentherapie-hildesheim.de.
authors.forename: A
authors.initials: A
authors.lastname: Meyer
authors.affiliation: Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. christiansen.hans@mh-hannover.de.
authors.forename: H
authors.initials: H
authors.lastname: Christiansen
authors.affiliation: Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. bremer.michael@mh-hannover.de.
authors.forename: M
authors.initials: M
authors.lastname: Bremer
authors.affiliation: Department of Pneumology, Thoracic Oncology and Respiratory Medicine, Frankenburgstr, 31, 48431, Rheine, Germany. n.dickgreber@mathias-spital.de.
authors.forename: N
authors.initials: N
authors.lastname: Dickgreber
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008168:Lung / Q000528:radiation effects; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010315:Particle Accelerators; D011239:Prednisolone / Q000008:administration & dosage; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D011829:Radiation Dosage; D017564:Radiation Pneumonitis / Q000188:drug therapy* / Q000209:etiology*; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000379:methods; D012907:Smoking; D013256:Steroids / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D013256:Steroids; D011239:Prednisolone
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