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Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer?

Publication ,  Journal Article
Miller, KL; Shafman, TD; Anscher, MS; Zhou, S-M; Clough, RW; Garst, JL; Crawford, J; Rosenman, J; Socinski, MA; Blackstock, W; Sibley, GS; Marks, LB
Published in: Int J Radiat Oncol Biol Phys
January 1, 2005

PURPOSE: To assess the incidence of clinically significant bronchial stenosis in patients treated with high doses (i.e., >70 Gy) of twice-daily external beam radiation therapy (RT). METHODS AND MATERIALS: The outcomes of 103 patients with unresectable non-small-cell lung cancer, treated twice daily to doses ranging from 7080 to 8640 cGy between 1992 and 2001, were analyzed. Most were treated on prospective clinical trials. For the dose-effect comparison, the patients were divided on the basis of the total dose: 67 received 74 Gy (range, 70.8-74.5 Gy; median, 73.6 Gy), 20 received 80 Gy, and 16 received 86 Gy (range, 85.2-86.4 Gy; median, 86.4 Gy). Sixty-six patients received sequential chemotherapy before RT. RT-induced bronchial stenosis was defined as symptomatic airway narrowing diagnosed by bronchoscopy or computed tomography scan without evidence of recurrent tumor in that region. RESULTS: Eight patients developed RT-induced, clinically significant, bronchial stenosis 2-48 months (median, 6 months) after RT. The 1-year and 4-year actuarial rate of stenosis was 7% and 38%, respectively. The median overall survival was 2.5 years (5 of 8 were alive at the writing of this report). A suggestion was also found of a dose-response effect with external beam radiotherapy-induced stenosis, with a rate of 4% and 25% at a dose of approximately 74 Gy and 86 Gy, respectively. CONCLUSION: Radiation therapy-induced bronchial stenosis is a significant clinical complication of dose escalation for lung cancer. This complication has been previously mentioned in the literature, but ours is the largest report to date, and the findings suggest that the risk rises with increasing dose. It is likely that this process would manifest in more patients if their disease were controlled well enough for more prolonged survival.

Duke Scholars

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Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

January 1, 2005

Volume

61

Issue

1

Start / End Page

64 / 69

Location

United States

Related Subject Headings

  • Radiotherapy Dosage
  • Radiation Injuries
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Humans
  • Female
  • Constriction, Pathologic
  • Carcinoma, Non-Small-Cell Lung
 

Citation

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Miller, K. L., Shafman, T. D., Anscher, M. S., Zhou, S.-M., Clough, R. W., Garst, J. L., … Marks, L. B. (2005). Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer? Int J Radiat Oncol Biol Phys, 61(1), 64–69. https://doi.org/10.1016/j.ijrobp.2004.02.066
Miller, Keith L., Timothy D. Shafman, Mitchell S. Anscher, Su-Min Zhou, Robert W. Clough, Jennifer L. Garst, Jeffrey Crawford, et al. “Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer?Int J Radiat Oncol Biol Phys 61, no. 1 (January 1, 2005): 64–69. https://doi.org/10.1016/j.ijrobp.2004.02.066.
Miller KL, Shafman TD, Anscher MS, Zhou S-M, Clough RW, Garst JL, et al. Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer? Int J Radiat Oncol Biol Phys. 2005 Jan 1;61(1):64–9.
Miller, Keith L., et al. “Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer?Int J Radiat Oncol Biol Phys, vol. 61, no. 1, Jan. 2005, pp. 64–69. Pubmed, doi:10.1016/j.ijrobp.2004.02.066.
Miller KL, Shafman TD, Anscher MS, Zhou S-M, Clough RW, Garst JL, Crawford J, Rosenman J, Socinski MA, Blackstock W, Sibley GS, Marks LB. Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer? Int J Radiat Oncol Biol Phys. 2005 Jan 1;61(1):64–69.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

January 1, 2005

Volume

61

Issue

1

Start / End Page

64 / 69

Location

United States

Related Subject Headings

  • Radiotherapy Dosage
  • Radiation Injuries
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Humans
  • Female
  • Constriction, Pathologic
  • Carcinoma, Non-Small-Cell Lung