Chemo-Radio-Immunotherapy for NSCLC III: ESR/ATS Thresholds for DL CO Correlate with Radiation Dosimetry and Pneumonitis Rate.

Autor: Stana M; Department of Radiation Oncology, Paracelsus Medical University, 5020 Salzburg, Austria., Grambozov B; Department of Radiation Oncology, Paracelsus Medical University, 5020 Salzburg, Austria., Karner J; Department of Radiation Oncology, Paracelsus Medical University, 5020 Salzburg, Austria., Gollner I; Department of Radiation Oncology, Paracelsus Medical University, 5020 Salzburg, Austria., Gaisberger C; Department of Radiation Oncology, Paracelsus Medical University, 5020 Salzburg, Austria., Ruznic E; Department of Radiation Oncology, Paracelsus Medical University, 5020 Salzburg, Austria., Zellinger B; Institute of Pathology, Paracelsus Medical University, 5020 Salzburg, Austria., Moosbrugger R; Department of Pulmonology, Paracelsus Medical University, 5020 Salzburg, Austria., Studnicka M; Department of Pulmonology, Paracelsus Medical University, 5020 Salzburg, Austria., Fastner G; Department of Radiation Oncology, Paracelsus Medical University, 5020 Salzburg, Austria., Sedlmayer F; Department of Radiation Oncology, Paracelsus Medical University, 5020 Salzburg, Austria., Zehentmayr F; Department of Radiation Oncology, Paracelsus Medical University, 5020 Salzburg, Austria.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2023 Mar 25; Vol. 15 (7). Date of Electronic Publication: 2023 Mar 25.
DOI: 10.3390/cancers15071966
Abstrakt: Introduction: Durvalumab following chemoradiotherapy (CRT) for non-small cell lung cancer stage III has become the standard of care (SoC) in the past few years. With this regimen, 5-year overall survival (OS) has risen to 43%. Therefore, adequate pulmonary function (PF) after treatment is paramount in long-term survivors. In this respect, carbon monoxide diffusing capacity (DL CO ), which represents the alveolar compartment, seems to be a suitable measure for residual lung capacity. The aim of the current analysis was to correlate DL CO with pneumonitis and radiation dose.
Patients and Methods: One hundred and twelve patients with histologically confirmed NSCLC III treated between 2015/10 and 2022/03 were eligible for this study. Patients received two cycles of platinum-based induction chemotherapy followed by high-dose radiotherapy (RT). As of 2017/09, durvalumab maintenance therapy was administered for one year. The clinical endpoints were based on the thresholds jointly published by the European Respiratory Society (ERS) and the American Thoracic Society (ATS). Pre-treatment DL CO of 60% was correlated to the incidence of pneumonitis, whereas the post-treatment DL CO decline of 10% was related to radiation dose.
Results: Patients with a pre-treatment DL CO < 60% had a higher probability of pneumonitis ( n = 98; r = 0.175; p -value 0.042), which could be reproduced in the subgroup of patients who did not receive durvalumab ( n = 40; r = 0.288; p -value 0.036). In these individuals, the decline in DL CO ≥ 10% depended significantly on the size of the lung volume receiving between 45% and 65% (V 65-45% ) of the total radiation dose (r = 0.354; p -value = 0.020) and V 20 Total Lung (r = 0.466; corrected p -value = 0.042).
Conclusions: The current analysis revealed that DL CO is a predictor for clinically relevant pneumonitis and a monitoring tool for post-treatment lung function as it correlates with radiation dose. This underlines the importance of peri-treatment lung function testing.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje