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Relationship between dose–volume parameters and pulmonary complications after neoadjuvant chemoradiotherapy followed by surgery for lung cancer

Zusammenhang zwischen Dosis-Volumen-Parametern und pulmonalen Komplikationen nach neoadjuvanter Radiochemotherapie und nachfolgender Operation beim Bronchialkarzinom

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Abstract

Purpose

This study evaluated the relationship between dose–volume histogram (DVH) parameters and pulmonary complications after neoadjuvant chemoradiotherapy (NACRT) followed by surgery for lung cancer. We also examined a new DVH parameter, because the unresected lung should be more spared than the later resected lung.

Patients and methods

Data from 43 non-small cell lung cancer patients were retrospectively analyzed. The DVH parameters of the lung were calculated from the total bilateral lung volume minus (1) the gross tumor volume (DVHg) or (2) the later resected lung volume (DVHr). Radiation pneumonitis (RP) and fistula, including bronchopleural and pulmonary fistula, were graded as the pulmonary complications. Factors affecting the incidences of grade 2 or higher RP (≥G2 RP) and fistula were analyzed.

Results

Sixteen patients (37 %) experienced ≥G2 RP and a V20 value of the total lung minus the later resected lung (V20r) ≥ 12 % was a significant factor affecting the incidence of ≥G2 RP (p = 0.032). Six patients (14 %) developed a fistula and a V35 value of the total lung minus the gross tumor (V35g) ≥ 19 % and a V40g ≥ 16 % were significant factors affecting the incidence of fistula (p = 0.002 and 0.009, respectively).

Conclusion

These DVH parameters may be related to the incidences of ≥G2 RP and fistula.

Zusammenfassung

Zielsetzung

In dieser Studie wurde die Beziehung zwischen Dosis-Volumen-Histogramm-(DVH-)Parametern und pulmonalen Komplikationen nach neoadjuvanter Radiochemotherapie (NARCT) und nachfolgender Operation beim Lungenkarzinom untersucht. Zudem wurde ein neuer DVH-Parameter untersucht, da das nichtresezierte Lungengewebe mehr geschont werden sollte als reseziertes Gewebe.

Patienten und Methoden

Daten von 43 Patienten mit nicht-kleinzelligem Bronchialkarzinom wurden retrospektiv analysiert. Die DVH-Parameter der Lunge wurden aus dem gesamten beidseitigen Lungenvolumen minus (1) das makroskopische Tumorvolumen (DVHg) oder (2) das resezierte Lungenvolumen (DVHr) ermittelt. Strahlenpneumonitis (RP) und Fisteln, einschließlich bronchopleuraler und pulmonaler Fisteln, wurden als pulmonale Komplikationen nach Graden abgestuft. Außerdem erfolgte eine Analyse der Faktoren, welche die Inzidenz einer RP von Grad 2 oder höher (≥G2 RP) und von Fisteln beeinflussen.

Ergebnisse

Bei 16 Patienten (37 %) wurde eine RP ≥G2 festgestellt, wobei der V20-Wert des Gesamtlungenvolumens minus dem später resezierten Lungenvolumen (V20r)≥ 12 % ein signifikanter Einflussfaktor bezüglich der Inzidenz einer RP ≥G2 war (p = 0,032). Insgesamt 6 Patienten (14 %) entwickelten eine Fistel. Signifikante Einflussfaktoren bezüglich der Inzidenz von Fisteln waren ein V35- bzw. V40-Wert des Gesamtlungenvolumens minus dem Gesamttumorvolumen V35g ≥ 19 % und V40g ≥ 16 % (p = 0,002 bzw. 0,009).

Schlussfolgerung

Diese DVH-Parameter stehen möglicherweise im Zusammenhang mit einer RP ≥G2 und Fisteln.

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Acknowledgements

This study was supported by a Grant-in-Aid for Cancer Research (H23-009) from the Ministry of Health, Labour and Welfare of Japan, and JSPS KAKENHI Grant Numbers 26461892 and 15K19798.

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Authors and Affiliations

  1. Department of Radiation Oncology, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, 761-0793, Kagawa, Japan

    Shigeo Takahashi MD & Toru Shibata MD, PhD

  2. Department of General Thoracic, Breast and Endocrine Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan

    Tetsuhiko Go MD, PhD, Yoshitaka Kasai MD, PhD & Hiroyasu Yokomise MD, PhD

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  1. Shigeo Takahashi MD
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  2. Tetsuhiko Go MD, PhD
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  3. Yoshitaka Kasai MD, PhD
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  4. Hiroyasu Yokomise MD, PhD
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  5. Toru Shibata MD, PhD
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Corresponding author

Correspondence to Shigeo Takahashi MD.

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Conflict of interest

S. Takahashi, T. Go, Y. Kasai, H. Yokomise, and T. Shibata state that there are no conflicts of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Takahashi, S., Go, T., Kasai, Y. et al. Relationship between dose–volume parameters and pulmonary complications after neoadjuvant chemoradiotherapy followed by surgery for lung cancer. Strahlenther Onkol 192, 658–667 (2016). https://doi.org/10.1007/s00066-016-1021-9

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  • DOI: https://doi.org/10.1007/s00066-016-1021-9

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