title: Decreased Risk of Radiation Pneumonitis With Coincident Concurrent Use of Angiotensin-converting Enzyme Inhibitors in Patients Receiving Lung Stereotactic Body Radiation Therapy.
abstract: OBJECTIVE
  Angiotensin-converting enzyme inhibitors (ACEi) have demonstrated decreased rates of radiation-induced lung injury in animal models and clinical reports have demonstrated decreased pneumonitis in the setting of conventionally fractionated radiation to the lung. We tested the role of ACEi in diminishing rates of symptomatic (grade ≥2) pneumonitis in the setting of lung stereotactic body radiation therapy (SBRT).
  
  
  METHODS
  We analyzed patients treated with thoracic SBRT to 48 to 60 Gy in 4 to 5 fractions from 2006 to 2014. We reviewed pretreatment and posttreatment medication profiles to document use of ACEi, angiotensin receptor blockers, bronchodilators, aspirin, PDE-5 inhibitors, nitrates, and endothelin receptor antagonists. Pneumonitis was graded posttreatment based on Common Terminology Criteria for Adverse Events Version 4.0. Univariate and multivariate analysis was performed and time to development of pneumonitis was evaluated by the Kaplan-Meier method.
  
  
  RESULTS
  A total of 189 patients were evaluated with a median follow-up of 24.8 months. The overall 1-year rate of symptomatic pneumonitis was 13.2%. The 1-year rate of symptomatic pneumonitis was 4.2% for ACEi users versus 16.3% in nonusers (P=0.03). On univariate analysis, the odds of developing grade 2 or greater pneumonitis were significantly lower for patients on ACEi (P=0.03). On multivariate analysis, after controlling for clinicopathologic characteristics and dosimetric endpoints, there was a significant association between ACEi use and decreased risk of clinical pneumonitis (P=0.04). Angiotensin receptor blockers or other bronchoactive medications did not show significant associations with development of pneumonitis.
  
  
  CONCLUSIONS
  Incidental concurrent use of ACEi demonstrated efficacy in diminishing rates of symptomatic pneumonitis in the setting of lung SBRT.
authors: Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Stritch School of Medicine Loyola University Chicago, Maywood.
authors: Fiori
authors: F
authors: Alite
authors: Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Stritch School of Medicine Loyola University Chicago, Maywood.
authors: Neelam
authors: N
authors: Balasubramanian
authors: Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Stritch School of Medicine Loyola University Chicago, Maywood.
authors: William
authors: W
authors: Adams
authors: Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Stritch School of Medicine Loyola University Chicago, Maywood.
authors: Murat
authors: M
authors: Surucu
authors: Department of Statistics, Lewis University, Romeoville, IL.
authors: Ibrahim
authors: I
authors: Mescioglu
authors: Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Stritch School of Medicine Loyola University Chicago, Maywood.
authors: Matthew M
authors: MM
authors: Harkenrider
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011832:Radiation Injuries / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D017564:Radiation Pneumonitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects*; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors