Optimizing lung cancer radiation therapy: A systematic review of multifactorial risk assessment for radiation-induced lung toxicity

医学 DLCO公司 放射治疗 肺癌 肺功能测试 扩散能力 慢性阻塞性肺病 肿瘤科 肺毒性 癌症 肺容积 肺活量 内科学 肺功能
作者
Rayan Bensenane,Sylvie Helfré,Kim Cao,Matthieu Carton,Laurence Champion,Nicolas Girard,Matthieu Glorion,Thibaut Vieira,Waïsse Waïssi,G. Créhange,Arnaud Beddok
出处
期刊:Cancer Treatment Reviews [Elsevier BV]
卷期号:124: 102684-102684 被引量:11
标识
DOI:10.1016/j.ctrv.2024.102684
摘要

Abstract

Background

Radiation therapy (RT) is essential in treating advanced lung cancer, but may lead to radiation pneumonitis (RP). This systematic review investigates the use of pulmonary function tests (PFT) and other parameters to predict and mitigate RP, thereby improving RT planning.

Methods

A systematic review sifted through PubMed and on BioMed Central, targeting articles from September 2005 to December 2022 containing the keywords: Lung Cancer, Radiotherapy, and pulmonary function test.

Results

From 1153 articles, 80 were included. RP was assessed using CTCAEv.4 in 30 % of these. Six studies evaluated post-RT quality of life in lung cancer patients, reporting no decline. Patients with RP and chronic obstructive pulmonary disease (COPD) generally exhibited poorer overall survival. Notably, forced expiratory volume in one second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) declined 24 months post-RT, while forced vital capacity (FVC) stayed stable. In the majority of studies, age over 60, tumors located in the lower part of the lung, and low FEV1 before RT were associated with a higher risk of RP. Dosimetric factors (V5, V20, MLD) and metabolic imaging emerged as significant predictors of RP risk. A clinical checklist blending patient and tumor characteristics, PFT results, and dosimetric criteria was proposed for assessing RP risk before RT.

Conclusion

The review reveals the multifactorial nature of RP development following RT in lung cancer. This approach should guide individualized management and calls for a prospective study to validate these findings and enhance RP prevention strategies.
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