Clinical Research Papers:
Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer
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Jing Zhao1,2,*, Regina M. Day3,*, Jian-Yue Jin2,4, Leslie Quint5, Hadyn Williams6, Catherine Ferguson2, Li Yan2, Maurice King2, Ahmad Albsheer2, Martha Matuszak7 and Feng-Ming (Spring) Kong2,8
1Department of Oncology, Tongji Hospital, Tongji Medial College, Huazhong University of Science and Technology, Wuhan, Hubei, China
2Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
3Department of Pharmacology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
4Department of Radiation Oncology, Radiation Physics, Indiana University School of Medicine, Indianapolis, IN, USA
5Department of Radiology, University of Michigan, Ann Arbor, MI, USA
6Department of Radiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
7Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
8Department of Radiation Oncology, IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
*These authors contributed equally to this work
Feng-Ming (Spring) Kong, email: [email protected]
Keywords: lung cancer, thoracic radiotherapy, radiation induced pleural effusion, risk factors, overall survival
Received: May 07, 2017 Accepted: June 08, 2017 Published: June 29, 2017
The risk factors and potential practice implications of radiation-induced pleural effusion (RIPE) are undefined. This study examined lung cancer patients treated with thoracic radiation therapy (TRT) having follow-up computed tomography (CT) or 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. Increased volumes of pleural effusion after TRT without evidence of tumor progression was considered RIPE. Parameters of lung dose-volume histogram including percent volumes irradiated with 5-55 Gy (V5-V55) and mean lung dose (MLD) were analyzed by receiver operating characteristic analysis. Clinical and treatment-related risk factors were detected by univariate and multivariate analyses. 175 out of 806 patients receiving TRT with post-treatment imaging were included. 51 patients (24.9%) developed RIPE; 40 had symptomatic RIPE including chest pain (47.1%), cough (23.5%) and dyspnea (35.3%). Female (OR = 0.380, 95% CI: 0.156–0.926, p = 0.033) and Caucasian race (OR = 3.519, 95% CI: 1.327–9.336, p = 0.011) were significantly associated with lower risk of RIPE. Stage and concurrent chemotherapy had borderline significance (OR = 1.665, p = 0.069 and OR = 2.580, p = 0.080, respectively) for RIPE. Patients with RIPE had significantly higher whole lung V5-V40, V50 and MLD. V5 remained as a significant predictive factor for RIPE and symptomatic RIPE (p = 0.007 and 0.022) after adjusting for race, gender and histology. To include, the incidence of RIPE is notable. Whole lung V5 appeared to be the most significant independent risk factor for symptomatic RIPE.
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