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Radiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-TKIs: is there any difference from stereotactic body radiotherapy alone?

Publication ,  Journal Article
Tang, X; Shen, Y; Meng, Y; Hou, L; Zhou, C; Yu, C; Jia, H; Wang, W; Ren, G; Cai, J; Li, XA; Yang, H; Kong, F-MS
Published in: Ann Palliat Med
March 2021

BACKGROUND: To quantitatively evaluate lung damage after treatment of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and stereotactic body radiotherapy (SBRT) in patients with nonsmall cell lung cancer (NSCLC), and compare that of SBRT only treatment. METHODS: Eligible patients from an IRB-approved prospective clinical trial had one month of EGFRTKIs treatment followed by SBRT (TKI + SBRT) and with 3-month follow-up high resolution CT. NSCLC patients treated with SBRT alone during the same time period without EGFR-TKIs or other systemic therapies were identified as controls. The lung damage was assessed clinically by pneumonitis and quantitatively using by CT intensity (Hounsfield unit, HU) changes. The mean HU values were extracted for regions of the lungs receiving the same dose range at 10 Gy intervals to generate dose-response curves (DRC). The relationship of HU changes and radiation dose was modeled using a Probit model. RESULTS: Four out of 20 (25%) TKI + SBRT patients and none of 19 (0%) SBRT alone patients had developed grade 2 and above pneumonitis (P=0.053), respectively. Sixty percent of TKI + SBRT patients and 30% SBRT alone patients had HU changes of the normal lung density >200 HU, respectively. There were significant differences in the DRC and in lung HU changes between the two groups (all P<0.05). The physical dose for a 50% complication risk (TD50) of CT lung damage was 52 Gy (CI: 46-59) in TKI + SBRT group versus 72 Gy (CI: 58-107) in SBRT alone group (P<0.01). CONCLUSIONS: Compared to patients treated with SBRT alone, patients treated with EGFR-TKIs followed by SBRT were more incline to develop radiation pneumonitis, and resulted in greater lung CT intensity changes and steeper dose-CT lung damage response relationship at 3 months post treatment. Future study with larger number of patients and longer follow-up period is warranted to validate this finding.

Duke Scholars

Published In

Ann Palliat Med

DOI

EISSN

2224-5839

Publication Date

March 2021

Volume

10

Issue

3

Start / End Page

2832 / 2842

Location

China

Related Subject Headings

  • Radiosurgery
  • Protein Kinase Inhibitors
  • Prospective Studies
  • Lung Neoplasms
  • Lung
  • Humans
  • ErbB Receptors
  • Carcinoma, Non-Small-Cell Lung
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Tang, X., Shen, Y., Meng, Y., Hou, L., Zhou, C., Yu, C., … Kong, F.-M. (2021). Radiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-TKIs: is there any difference from stereotactic body radiotherapy alone? Ann Palliat Med, 10(3), 2832–2842. https://doi.org/10.21037/apm-20-1116
Tang, Xingni, Yichao Shen, Yinnan Meng, Liqiao Hou, Chao Zhou, Changhui Yu, Haijian Jia, et al. “Radiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-TKIs: is there any difference from stereotactic body radiotherapy alone?Ann Palliat Med 10, no. 3 (March 2021): 2832–42. https://doi.org/10.21037/apm-20-1116.
Tang, Xingni, et al. “Radiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-TKIs: is there any difference from stereotactic body radiotherapy alone?Ann Palliat Med, vol. 10, no. 3, Mar. 2021, pp. 2832–42. Pubmed, doi:10.21037/apm-20-1116.
Tang X, Shen Y, Meng Y, Hou L, Zhou C, Yu C, Jia H, Wang W, Ren G, Cai J, Li XA, Yang H, Kong F-MS. Radiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-TKIs: is there any difference from stereotactic body radiotherapy alone? Ann Palliat Med. 2021 Mar;10(3):2832–2842.

Published In

Ann Palliat Med

DOI

EISSN

2224-5839

Publication Date

March 2021

Volume

10

Issue

3

Start / End Page

2832 / 2842

Location

China

Related Subject Headings

  • Radiosurgery
  • Protein Kinase Inhibitors
  • Prospective Studies
  • Lung Neoplasms
  • Lung
  • Humans
  • ErbB Receptors
  • Carcinoma, Non-Small-Cell Lung