title: Clinical characteristics and dose-volume histogram parameters associated with the development of pleural effusions in non-small cell lung cancer patients treated with chemoradiation therapy.
abstract: BACKGROUND
  To investigate descriptive characteristics and dose metric (DM) parameters associated with development of pleural effusions (PlEf) in non-small cell lung cancer (NSCLC) treated with definitive chemoradiation therapy (CRT).
  
  
  METHODS
  We retrospectively assessed treatment records and follow-up imaging of 66 NSCLC patients to identify PlEf formation after CRT. PlEf association between mean heart dose (MHD), mean lung dose (MLD), heart V5-V60 (HV), and lung V5-V60 (LV) were evaluated using Cox Proportional Hazard Models.
  
  
  RESULTS
  A total of 52% (34 of 66 patients) of our population developed PlEf and the actuarial rates at 6 months, 12 months, and 18 months were 7%, 30%, and 42%, respectively. Median time to diagnosis was five months (range 0.06-27 months). The majority of PlEfs were grade one (67%) and developed at a median of four (0.06-13) months, followed by grade two (15%) at a median 11 (5-12) months, and grade three (18%) at a median of 11 (3-27) months. On multivariate analysis, increasing HV5-HV50, LV5-LV50, MHD, and MLD were associated with greater risk of PlEf. Higher grade PlEf was also associated with higher doses of radiation to the heart, while lung DM parameters were not significantly associated with higher PlEf grades. At five-months post-CRT, MHD of 25 Gy was associated with a 100% chance of grade one PlEf, an 82% risk of grade two PlEf, and a 19% risk of grade three PlEf.
  
  
  CONCLUSIONS
  Post-CRT PlEf is common in NSCLC with the majority being grade one. Increasing heart and lung irradiation was associated with increased risk of PlEf. Increasing heart irradiation also correlated with development of increasing grades of PlEf. The impact of potential cardiopulmonary toxicity and resultant PlEfs after CRT requires additional study.
authors.affiliation: a Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology , Robert Wood Johnson Medical School, Rutgers University , New Brunswick , NJ , USA ;
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Deek
authors.affiliation: b Harvard/MGH Center on Genomics , Massachusetts General Hospital , Boston , MA , USA ;
authors.forename: Sairaman
authors.initials: S
authors.lastname: Nagarajan
authors.affiliation: c School of Public Health, Department of Biostatistics , Rutgers University , New Brunswick , NJ , USA ;
authors.forename: Sinae
authors.initials: S
authors.lastname: Kim
authors.affiliation: a Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology , Robert Wood Johnson Medical School, Rutgers University , New Brunswick , NJ , USA ;
authors.forename: Inaya
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: a Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology , Robert Wood Johnson Medical School, Rutgers University , New Brunswick , NJ , USA ;
authors.forename: Shiby
authors.initials: S
authors.lastname: Paul
authors.affiliation: a Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology , Robert Wood Johnson Medical School, Rutgers University , New Brunswick , NJ , USA ;
authors.forename: Eli D
authors.initials: ED
authors.lastname: Scher
authors.affiliation: d Department of Medicine , New Jersey Medical School, Rutgers University , Newark , NJ , USA ;
authors.forename: Matthew
authors.initials: M
authors.lastname: Listo
authors.affiliation: a Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology , Robert Wood Johnson Medical School, Rutgers University , New Brunswick , NJ , USA ;
authors.forename: Andrew
authors.initials: A
authors.lastname: Chen
authors.affiliation: e Rutgers Cancer Institute of New Jersey, Division of Medical Oncology , Robert Wood Johnson Medical School, Rutgers University , New Brunswick , NJ , USA ;
authors.forename: Joseph
authors.initials: J
authors.lastname: Aisner
authors.affiliation: f Division of Pulmonary and Critical Care Medicine, Department of Medicine , Robert Wood Johnson Medical School, Rutgers University , New Brunswick , NJ , USA.
authors.forename: Sabiha
authors.initials: S
authors.lastname: Hussain
authors.affiliation: a Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology , Robert Wood Johnson Medical School, Rutgers University , New Brunswick , NJ , USA ;
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
authors.affiliation: a Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology , Robert Wood Johnson Medical School, Rutgers University , New Brunswick , NJ , USA ;
authors.forename: Salma K
authors.initials: SK
authors.lastname: Jabbour
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008168:Lung / Q000528:radiation effects; D008175:Lung Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D010996:Pleural Effusion / Q000139:chemically induced / Q000209:etiology*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies