Abnormal pulmonary function tests predict the development of radiation-induced pneumonitis in advanced non-small cell lung Cancer

L Torre-Bouscoulet, W R Muñoz-Montaño, D Martínez-Briseño, F J Lozano-Ruiz, R Fernández-Plata, J A Beck-Magaña, C García-Sancho, A Guzmán-Barragán, E Vergara, M Blake-Cerda, L Gochicoa-Rangel, F Maldonado, M Arroyo-Hernández, O Arrieta, L Torre-Bouscoulet, W R Muñoz-Montaño, D Martínez-Briseño, F J Lozano-Ruiz, R Fernández-Plata, J A Beck-Magaña, C García-Sancho, A Guzmán-Barragán, E Vergara, M Blake-Cerda, L Gochicoa-Rangel, F Maldonado, M Arroyo-Hernández, O Arrieta

Abstract

Background: Radiation pneumonitis (RP) is a frequent complication of concurrent chemoradiotherapy (CCRT) and is associated with severe symptoms that decrease quality of life and might result in pulmonary fibrosis or death. The aim of this study is to identify whether pulmonary function test (PFT) abnormalities may predict RP in non-small cell lung cancer (NSCLC) patients.

Methods: A prospective multi-institutional study was conducted with locally advanced and oligometastatic NSCLC patients. All participants were evaluated at baseline, end of CCRT, week 6, 12, 24, and 48 post-CCRT. They completed forced spirometry with a bronchodilator, body plethysmography, impulse oscillometry, carbon monoxide diffusing capacity (DLCO), molar mass of CO2, six-minute walk test and exhaled fraction of nitric oxide (FeNO). Radiation pneumonitis was assessed with RTOG and CTCAE. The protocol was registered in www.clinicaltrials.gov (NCT01580579), registered April 19, 2012.

Results: Fifty-two patients were enrolled; 37 completed one-year follow-up. RP ≥ Grade 2 was present in 11/37 (29%) for RTOG and 15/37 (40%) for CTCAE. Factors associated with RP were age over 60 years and hypofractionated dose. PFT abnormalities at baseline that correlated with the development of RP included lower forced expiratory volume in one second after bronchodilator (p = 0.02), DLCO (p = 0.02) and FeNO (p = 0.04). All PFT results decreased after CCRT and did not return to basal values at follow-up.

Conclusions: FEV1, DLCO and FeNO prior to CCRT predict the development of RP in NSCLC. This study suggests that all patients under CCRT should be assessed by PFT to identify high-risk patients for close follow-up and early treatment.

Keywords: Non-small cell lung Cancer; Pneumonitis; Pulmonary function tests; Radiotherapy.

Conflict of interest statement

Ethics approval and consent to participate

The protocol was approved by the Scientific and Bioethical committees of the Instituto Nacional de Cancerología (013/014/ICI; CEI/799) and the Instituto Nacional de Enfermedades Respiratorias in Mexico (C12–12). The protocol is registered in www.clinicaltrials.gov (NCT01580579). All patients signed informed consent.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Consort flow diagram of the patients enrolled in this study
Fig. 2
Fig. 2
Changes in PFT tests during follow up, (a) FEV1, (b) Carbon Monoxide Diffusing Capacity, (c) Fraction of exhaled nitric oxide

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