방사선의학 웹진

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Abstract
Background and purpose: This study aimed to investigate the predictive factors of severe radiation-induced lung injury (RILI) in patients with lung cancer and coexisting interstitial lung disease (ILD) undergoing conventionally fractionated thoracic radiotherapy.

Materials and methods: The study includes consecutive patients treated with thoracic radiotherapy for lung cancer at two tertiary centers between 2010 and 2021. RILI severity was graded using the National Cancer Institute Common Terminology Criteria version 5.0, with severe RILI defined as toxicity grade ≥4, and symptomatic RILI as grade ≥2. The absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and C-reactive protein were collected within 4 weeks before starting radiotherapy. Neutrophil-lymphocyte ratios (NLR) were calculated as ANC/ALC. The median follow-up was 9 (range, 6-114) months.

Results: Among 54 patients, 22 (40.7 %) had severe RILI. On multivariate logistic regression analysis, high pretreatment ANC (p = 0.030, OR = 4.313), pretreatment NLR (p = 0.007, OR = 5.784), and ILD severity (p = 0.027, OR = 2.416) were significant predictors of severe RILI. Dosimetric factors were not associated with severe RP. Overall survival was significantly worse for patients with severe RILI than those without, with 1-year cumulative overall survival rates of 7.4 % and 62.8 %, respectively.

Conclusion: Pretreatment blood NLR, ANC, and ILD severity were associated with severe RILI. Overall survival was dismal for patients with severe RILI.

폐암으로 방사선치료를 받은 환자의 방사선치료전, 방사선치료 4주후, 7주후 촬영한 흉부 CT 사진으로 시간이 경과할수록 간유리음영, 섬유화가 양쪽 폐로 진행되는 것을 확인할 수 있습니다.

Affiliations

Shin-Hyung Park 1, Jae-Kwang Lim 2, Min Kyu Kang 3, Jongmoo Park 3, Chae Moon Hong 4, Chang Ho Kim 5, Seung Ick Cha 5, Jaehee Lee 5, Seoung-Jun Lee 6, Jae-Chul Kim 3
1Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Cardiovascular Research Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: shinhyungpark@knu.ac.kr.
2Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
3Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
4Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
5Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
6Department of Radiation Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea.