Driever, E.M. (2014) Normal tissue complication probability model for radiation pneumonitis in patients with non-small cell lung cancer treated with radiotherapy and concomitant gemcitabine. thesis, Medicine.
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Abstract
Background: Radiotherapy is the backbone in the treatment of locally advanced non-small cell lung cancer (NSCLC) stage III. The most common and clinically important subacute toxicity of thoracic radiotherapy is radiation pneumonitis. Multiple patient, tumor and treatment characteristics associated with radiation pneumonitis have been identified in the literature. Predictive models, like the normal tissue complication probability (NTCP) models, based on dose-volume parameters are useful tools in the treatment planning process. The purpose of this study was to develop an NTCP model for radiation pneumonitis in a cohort of amply 300 patients treated with radiotherapy with or without cisplatinum-gemcitabine based chemotherapy. Methods: Clinical data of patient with histological proven locally advanced NSCLC who were nog eligible for surgery were retrieved from the hospital patient records at the department of radiation oncology and at all referring pulmonology departments in the Northern Netherlands. The patients - included in this study- received chemo therapy at referring hospitals and radiotherapy at the university medical center Groningen between 2002 en 2010 and radiation pneumonitis was retrospectively scored using the Common Toxicity Criteria (CTCAE 3.0). All statistical analyses were carried out using SPSS version 20. Descriptive statistics were calculated to characterize the patient, disease, treatment and pattern of recurrence features. Survival and tumor progression were estimated using the Kaplan-Meijer method. Logistic regression and Cox regression were used to determine the prognostic factors for progression of the disease, survival and the risk for radiation pneumonitis. Results: The median age was 64 years, ranging from 35 to 87. Median and minimal follow up of all surviving patients were 65 months and 37 months, respectively. Out of the 303 patients, 217 patients (72%) developed progression of the disease. The median overall survival was 20 months (95% confidence interval 16.77-23.22) with a 5-years survival of 21.4 %. On multivariable Cox regression analysis, sex, location, World Health Organization (WHO) performance status, planning tumor volume (PTV) and gemcitabine addition were significant prognostic factors for overall survival. Radiation pneumonitis -grade 2 or higher- was scored in 49 patients (16.2%). On multivariate analysis, the ratio between GTV an PTV, number of concomitant gemcitabine cycles, lung volume receiving more that V40 Gy and sex were statistically significant prognostic factors for radiation pneumonitis. Conclusion: In conclusion, the concomitantly administrated gemcitabine dose increased the risk of radiation pneumonitis in patients with locally advanced NSCLC. However, survival also increased with the weekly addition of concomitant gemcitabine, indicating that the toxic effect did not outweigh the beneficial effect of concomitant gemcitabine. Factors such as sex, tumor size and moderate dose to the lungs (V40Gy) were also related to the risk of radiation pneumonits and were incorporated in the developed NTCP model.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Widder, J. and Radiotherapy Oncology, University Medical Center Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1324 |
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