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Radiographic patterns of symptomatic radiation pneumonitis in lung cancer patients: Imaging predictors for clinical severity and outcome.
Lung Cancer. 2020 Jul; 145:132-139.LC

Abstract

OBJECTIVE

Investigate the spectrum of radiographic patterns of radiation pneumonitis (RP) in lung cancer patients and identify imaging markers for high-grade RP and RP-related death.

METHODS

Eighty-two patients with lung cancer treated with conventional chest radiotherapy who had symptomatic RP were identified from the radiation oncology database. The imaging features of RP were studied for association with high-grade RP (Grade ≥3) and RP-related death (Grade 5).

RESULTS

RP was Grade 2 in 60 (73%), Grade 3 in 15 (18%), and Grade 5 in 7 patients (9%). Lower performance status (p = 0.04), squamous cell histology (p = 0.03), and FEV1 ≤ 2 (p = 0.009) were associated with high-grade pneumonitis. Older age (p = 0.03) and squamous cell histology (p = 0.03) were associated with RP-related death. The CT findings included ground-glass and reticular opacities in all patients, with traction bronchiectasis in 77 (94%) and consolidation in 74 (90%). The most common radiographic pattern of RP was cryptogenic organizing pneumonia (COP) pattern (n = 54), followed by acute interstitial pneumonia (AIP)/acute respiratory distress syndrome (ARDS) pattern (n = 10). Higher extent of lung involvement, diffuse distribution, and AIP/ARDS pattern were associated with high-grade pneumonitis and RP-related death. AIP/ARDS pattern was a significant factor for high-grade pneumonitis (OR:12.62, p = 0.01) in multivariable analyses adjusting for clinical variables.

CONCLUSION

COP pattern was the most common radiographic pattern for symptomatic RP in lung cancer patients. AIP/ARDS pattern was significantly associated with high-grade RP and RP-related deaths, and was an independent marker for high-grade RP. The recognition of the radiographic patterns of RP can help to effectively contribute to patient management.

Authors+Show Affiliations

Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA; Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston MA, 02215, USA.Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA; Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address: Mizuki_Nishino@DFCI.HARVARD.EDU.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32447116

Citation

Thomas, Richard, et al. "Radiographic Patterns of Symptomatic Radiation Pneumonitis in Lung Cancer Patients: Imaging Predictors for Clinical Severity and Outcome." Lung Cancer (Amsterdam, Netherlands), vol. 145, 2020, pp. 132-139.
Thomas R, Chen YH, Hatabu H, et al. Radiographic patterns of symptomatic radiation pneumonitis in lung cancer patients: Imaging predictors for clinical severity and outcome. Lung Cancer. 2020;145:132-139.
Thomas, R., Chen, Y. H., Hatabu, H., Mak, R. H., & Nishino, M. (2020). Radiographic patterns of symptomatic radiation pneumonitis in lung cancer patients: Imaging predictors for clinical severity and outcome. Lung Cancer (Amsterdam, Netherlands), 145, 132-139. https://doi.org/10.1016/j.lungcan.2020.03.023
Thomas R, et al. Radiographic Patterns of Symptomatic Radiation Pneumonitis in Lung Cancer Patients: Imaging Predictors for Clinical Severity and Outcome. Lung Cancer. 2020;145:132-139. PubMed PMID: 32447116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiographic patterns of symptomatic radiation pneumonitis in lung cancer patients: Imaging predictors for clinical severity and outcome. AU - Thomas,Richard, AU - Chen,Yu-Hui, AU - Hatabu,Hiroto, AU - Mak,Raymond H, AU - Nishino,Mizuki, Y1 - 2020/04/30/ PY - 2019/12/26/received PY - 2020/03/18/revised PY - 2020/03/24/accepted PY - 2021/07/01/pmc-release PY - 2020/5/25/pubmed PY - 2020/5/25/medline PY - 2020/5/25/entrez KW - Computed tomography KW - Imaging KW - Lung cancer KW - Pneumonitis KW - Radiation SP - 132 EP - 139 JF - Lung cancer (Amsterdam, Netherlands) JO - Lung Cancer VL - 145 N2 - OBJECTIVE: Investigate the spectrum of radiographic patterns of radiation pneumonitis (RP) in lung cancer patients and identify imaging markers for high-grade RP and RP-related death. METHODS: Eighty-two patients with lung cancer treated with conventional chest radiotherapy who had symptomatic RP were identified from the radiation oncology database. The imaging features of RP were studied for association with high-grade RP (Grade ≥3) and RP-related death (Grade 5). RESULTS: RP was Grade 2 in 60 (73%), Grade 3 in 15 (18%), and Grade 5 in 7 patients (9%). Lower performance status (p = 0.04), squamous cell histology (p = 0.03), and FEV1 ≤ 2 (p = 0.009) were associated with high-grade pneumonitis. Older age (p = 0.03) and squamous cell histology (p = 0.03) were associated with RP-related death. The CT findings included ground-glass and reticular opacities in all patients, with traction bronchiectasis in 77 (94%) and consolidation in 74 (90%). The most common radiographic pattern of RP was cryptogenic organizing pneumonia (COP) pattern (n = 54), followed by acute interstitial pneumonia (AIP)/acute respiratory distress syndrome (ARDS) pattern (n = 10). Higher extent of lung involvement, diffuse distribution, and AIP/ARDS pattern were associated with high-grade pneumonitis and RP-related death. AIP/ARDS pattern was a significant factor for high-grade pneumonitis (OR:12.62, p = 0.01) in multivariable analyses adjusting for clinical variables. CONCLUSION: COP pattern was the most common radiographic pattern for symptomatic RP in lung cancer patients. AIP/ARDS pattern was significantly associated with high-grade RP and RP-related deaths, and was an independent marker for high-grade RP. The recognition of the radiographic patterns of RP can help to effectively contribute to patient management. SN - 1872-8332 UR - https://www.unboundmedicine.com/medline/citation/32447116/Radiographic_patterns_of_symptomatic_radiation_pneumonitis_in_lung_cancer_patients:_Imaging_predictors_for_clinical_severity_and_outcome L2 - https://linkinghub.elsevier.com/retrieve/pii/S0169-5002(20)30353-6 DB - PRIME DP - Unbound Medicine ER -
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