Case series of 23 patients who developed fatal radiation pneumonitis after stereotactic body radiotherapy for lung cancer

Hiroshi Onishi, Kan Marino, Hideomi Yamashita, Atsuro Terahara, Rikiya Onimaru, Masaki Kokubo, Yoshiyuki Shioyama, Takuyo Kozuka, Yukinori Matsuo, Takashi Aruga, Masahiro Hiraoka

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Abstract

The purpose of this study was to examine the characteristics and treatment plans of patients who experienced fatal radiation pneumonitis after stereotactic body radiation therapy for primary or oligometastatic lung cancer. Records of 1789 patients treated with stereotactic body radiation therapy for primary or oligometastatic lung cancer were retrospectively reviewed to identify those who developed fatal radiation pneumonitis. Twenty-three (1.3%; 18 men and 5 women) patients developed fatal radiation pneumonitis after stereotactic body radiation therapy for lung cancer; their median age was 74 years. The mean Krebs von den Lungen-6 level and percent vital capacity were 1320 U/mL and 82%, respectively. Prestereotactic body radiation therapy computed tomography revealed pulmonary interstitial change in 14 (73.7%) of 19 patients in whom computed tomography data could be reviewed. Seven (30.4%) of 23 patients had regularly used steroids. The median time duration between stereotactic body radiation therapy commencement and pneumonia symptom appearance was 75 (range: 14-204) days. Median survival time following pneumonia symptom appearance was 53 (range: 4-802) days. The 6-and 12-month overall survival rates were 34.8% and 13.0%, respectively. The 6-month overall survival rates in patients with and without heart disease were 50.0%, 16.7%, and 46.7% for heart disease existence, respectively. There were 4 patients in whom fatal radiation pneumonitis occurred within 2 months after stereotactic body radiation therapy and who died within 1 month. Three of them had no pulmonary interstitial change before stereotactic body radiation therapy, but had heart disease. In summary, the survival time in this case series was generally short but varied widely. More than half of the patients had pulmonary interstitial change before stereotactic body radiation therapy, although immediately progressive fatal radiation pneumonitis was also observed in patients without pulmonary interstitial change. True risk factors for fatal radiation pneumonitis should be examined in a prospective study with a larger cohort.

Original languageEnglish
JournalTechnology in Cancer Research and Treatment
Volume17
DOIs
Publication statusPublished - Jan 1 2018

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Radiation Pneumonitis
Radiosurgery
Lung Neoplasms
Radiotherapy
Heart Diseases
Lung
Survival Rate
Tomography
Survival
Vital Capacity
Pneumonia
Steroids
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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Case series of 23 patients who developed fatal radiation pneumonitis after stereotactic body radiotherapy for lung cancer. / Onishi, Hiroshi; Marino, Kan; Yamashita, Hideomi; Terahara, Atsuro; Onimaru, Rikiya; Kokubo, Masaki; Shioyama, Yoshiyuki; Kozuka, Takuyo; Matsuo, Yukinori; Aruga, Takashi; Hiraoka, Masahiro.

In: Technology in Cancer Research and Treatment, Vol. 17, 01.01.2018.

Research output: Contribution to journalArticle

Onishi, Hiroshi ; Marino, Kan ; Yamashita, Hideomi ; Terahara, Atsuro ; Onimaru, Rikiya ; Kokubo, Masaki ; Shioyama, Yoshiyuki ; Kozuka, Takuyo ; Matsuo, Yukinori ; Aruga, Takashi ; Hiraoka, Masahiro. / Case series of 23 patients who developed fatal radiation pneumonitis after stereotactic body radiotherapy for lung cancer. In: Technology in Cancer Research and Treatment. 2018 ; Vol. 17.
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abstract = "The purpose of this study was to examine the characteristics and treatment plans of patients who experienced fatal radiation pneumonitis after stereotactic body radiation therapy for primary or oligometastatic lung cancer. Records of 1789 patients treated with stereotactic body radiation therapy for primary or oligometastatic lung cancer were retrospectively reviewed to identify those who developed fatal radiation pneumonitis. Twenty-three (1.3{\%}; 18 men and 5 women) patients developed fatal radiation pneumonitis after stereotactic body radiation therapy for lung cancer; their median age was 74 years. The mean Krebs von den Lungen-6 level and percent vital capacity were 1320 U/mL and 82{\%}, respectively. Prestereotactic body radiation therapy computed tomography revealed pulmonary interstitial change in 14 (73.7{\%}) of 19 patients in whom computed tomography data could be reviewed. Seven (30.4{\%}) of 23 patients had regularly used steroids. The median time duration between stereotactic body radiation therapy commencement and pneumonia symptom appearance was 75 (range: 14-204) days. Median survival time following pneumonia symptom appearance was 53 (range: 4-802) days. The 6-and 12-month overall survival rates were 34.8{\%} and 13.0{\%}, respectively. The 6-month overall survival rates in patients with and without heart disease were 50.0{\%}, 16.7{\%}, and 46.7{\%} for heart disease existence, respectively. There were 4 patients in whom fatal radiation pneumonitis occurred within 2 months after stereotactic body radiation therapy and who died within 1 month. Three of them had no pulmonary interstitial change before stereotactic body radiation therapy, but had heart disease. In summary, the survival time in this case series was generally short but varied widely. More than half of the patients had pulmonary interstitial change before stereotactic body radiation therapy, although immediately progressive fatal radiation pneumonitis was also observed in patients without pulmonary interstitial change. True risk factors for fatal radiation pneumonitis should be examined in a prospective study with a larger cohort.",
author = "Hiroshi Onishi and Kan Marino and Hideomi Yamashita and Atsuro Terahara and Rikiya Onimaru and Masaki Kokubo and Yoshiyuki Shioyama and Takuyo Kozuka and Yukinori Matsuo and Takashi Aruga and Masahiro Hiraoka",
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AU - Kokubo, Masaki

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