Clarithromycin mitigates radiation pneumonitis in patients with lung cancer treated with stereotactic body radiotherapy
| Autor: | Yohei Oku, Naoko Sanuki, Takeshi Akiba, Yousuke Aoki, Masaharu Shinkai, Etsuo Kunieda, Yuichiro Tsurugai, Tomikazu Mizuno, Yu Hara, Tatsuji Enomoto, Atsuya Takeda |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Lung Pulmonary toxicity medicine.drug_class business.industry Antibiotics medicine.disease Gastroenterology 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure 030220 oncology & carcinogenesis Clarithromycin Internal medicine medicine Original Article Respiratory system Prospective cohort study Lung cancer business Idiopathic interstitial pneumonia medicine.drug |
| Zdroj: | Journal of thoracic disease. 10(1) |
| ISSN: | 2072-1439 |
| Popis: | Background: Radiation pneumonitis is a critical pulmonary toxicity after irradiation of the lung. Macrolides including clarithromycin (CAM) are antibiotics. They also have immunomodulatory properties and are used to treat respiratory inflammatory diseases. Radiation pneumonitis has similar pathology to them. Adverse reactions to macrolides are few and self-limited. We thus administered CAM to patients with high-risk factors for radiation pneumonitis, and retrospectively investigated whether CAM mitigated radiation pneumonitis following stereotactic body radiotherapy (SBRT). Methods: Among consecutive patients treated with SBRT, we retrospectively examined lung cancer patients treated with a total dose of 40–60 Gy in 5–10 fractions and followed ≥6 months. Since January 2014, CAM has been administered in patients with pretreatment predictable radiation pneumonitis highrisk factors, including idiopathic interstitial pneumonias (IIPs), and elevated Krebs von den Lungen-6 (KL-6) and/or surfactant protein D (SP-D), and in patients developing early onset radiation pneumonitis. Results: Five hundred and eighty eligible patients were identified and divided into 445 patients during the non-CAM-administration era (non-CAM-era) (before December 2013) and 136 patients during the CAMadministration era (CAM-era) (after January 2014). Median follow-up durations were 38.0 and 13.9 months, respectively. The rates of radiation pneumonitis ≥ grade 2 and ≥ grade 3 were significantly lower in CAM-era (grade ≥2, 16% vs . 9.6%, P=0.047; grade ≥3, 3.8% vs . 0.73%, P=0.037). For patients with the pretreatment predictable high-risk factors, the rate of radiation pneumonitis ≥ grade 3 was significantly lower, and that of grade ≥2 had a lower tendency (grade ≥3, 7.2% vs . 0%, P=0.011; grade ≥2, 21% vs . 9.6%, P=0.061). For patients developing early onset radiation pneumonitis, the rate of radiation pneumonitis ≥ grade 3 was also significantly lower (23% vs . 0%, P Conclusions: CAM mitigated radiation pneumonitis following SBRT. The efficacy of CAM should be confirmed in prospective studies. |
| Databáze: | OpenAIRE |
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