Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: an international individual patient data meta-analysis.
Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: an international individual patient data meta-analysis.
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DOI：
10.1016/j.ijrobp.2012.04.043
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发表时间：
2013-02-01
影响因子：
7
通讯作者：
Rodrigues, George
中科院分区：
文献类型：
--
作者：
Palma, David A.;Senan, Suresh;Tsujino, Kayoko;Barriger, Robert B.;Rengan, Ramesh;Moreno, Marta;Bradley, Jeffrey D.;Kim, Tae Hyun;Ramella, Sara;Marks, Lawrence B.;De Petris, Luigi;Stitt, Larry;Rodrigues, George
放射性肺炎是接受同步放化疗（CCRT）治疗非小细胞肺癌（NSCLC）患者的剂量限制性毒性。我们进行了一项个体患者数据荟萃分析，以确定具有临床意义的肺炎的预测因素。在对文献进行系统回顾后，获得了欧洲、北美和亚洲836例接受CCRT的患者的数据。患者被随机分为训练集和验证集（2/3 vs. 1/3的患者）。使用逻辑回归评估症状性肺炎（通过几种评分系统之一≥ 2级）或致死性肺炎的预测因素。使用递归分区分析（RPA）来定义风险组。中位放疗剂量为60戈伊，中位随访时间为2.3年。大多数患者同时接受顺铂/依托泊苷（38%）或卡铂/紫杉醇（26%）。症状性肺炎的总体发生率为29.8%（n=249），致死性肺炎的发生率为1.9%（n=16）。在训练集中，预测症状性肺炎的因素是接受≥20戈伊（V20）的肺体积[OR：1.03/1%增加，p=0.008]和卡铂/紫杉醇化疗[OR：3.33，p<0.001]，具有年龄趋势[OR：1.24/10年，p=0.09];该模型在验证集中保持预测性，两个数据集都具有良好的区分度（c-统计量>0.65）。在RPA中，肺炎风险最高（>50%）的患者年龄>65岁，接受卡铂/紫杉醇治疗。致死性肺炎的预测因子是日剂量>2戈伊、V20和下叶肿瘤位置。一些治疗相关的危险因素可预测症状性肺炎的发生，接受卡铂-紫杉醇化疗的CCRT老年患者的风险最高。致死性肺炎虽然不常见，但与剂量因素和肿瘤位置有关。
Radiation pneumonitis is a dose-limiting toxicity for patients undergoing concurrent chemoradiation therapy (CCRT) for non-small cell lung cancer (NSCLC). We performed an individual patient data meta-analysis to determine factors predictive of clinically significant pneumonitis. After a systematic review of the literature, data was obtained on 836 patients who underwent CCRT in Europe, North America and Asia. Patients were randomly divided into training and validation sets (2/3 vs. 1/3 of patients). Factors predictive of symptomatic pneumonitis (grade ≥ 2 by one of several scoring systems) or fatal pneumonitis were evaluated using logistic regression. Recursive partitioning analysis (RPA) was used to define risk groups. The median radiotherapy dose was 60 Gy, and median follow-up was 2.3 years. Most patients received concurrent cisplatin/etoposide (38%) or carboplatin/paclitaxel (26%). The overall rate of symptomatic pneumonitis was 29.8% (n=249), with fatal pneumonitis in 1.9% (n=16). In the training set, factors predictive of symptomatic pneumonitis were lung volume receiving ≥20 Gy (V20) [OR:1.03 per 1% increase, p=0.008], and carboplatin/paclitaxel chemotherapy [OR:3.33, p<0.001], with a trend for age [OR: 1.24 per decade, p=0.09]; the model remained predictive in the validation set with good discrimination in both datasets (c-statistic>0.65). On RPA, the highest risk of pneumonitis (>50%) was in patients >65 years of age receiving carboplatin/paclitaxel. Predictors of fatal pneumonitis were daily dose >2 Gy, V20, and lower-lobe tumor location. Several treatment-related risk factors predict the development of symptomatic pneumonitis, and elderly patients who undergo CCRT with carboplatin-paclitaxel chemotherapy are at highest risk. Fatal pneumonitis, although uncommon, is related to dosimetric factors and tumor location.
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DOI：
10.1016/j.ijrobp.2009.06.091
发表时间：
2010-03-01
影响因子：
7
作者：
Marks, Lawrence B.;Bentzen, Soren M.;Deasy, Joseph O.;Kong, Feng-Ming (Spring);Bradley, Jeffrey D.;Vogelius, Ivan S.;El Naqa, Issam;Hubbs, Jessica L.;Lebesque, Joos V.;Timmerman, Robert D.;Martel, Mary K.;Jackson, Andrew
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Jackson, Andrew
影响因子：
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作者：
Kim, TH;Cho, KH;Kim, DY
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Kim, DY
影响因子：
45.3
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Yamamoto, Nobuyuki;Nakagawa, Kazuhiko;Fukuoka, Masahiro
通讯作者：
Fukuoka, Masahiro
影响因子：
50.5
作者：
Phernambucq, E. C. J.;Spoelstra, F. O. B.;Senan, S.
通讯作者：
Senan, S.
DOI：
10.1016/j.ijrobp.2009.09.030
发表时间：
2010-12-01
影响因子：
7
作者：
Barriger, R. Bryan;Fakiris, Achilles J.;McGarry, Ronald C.
通讯作者：
McGarry, Ronald C.