Complications of lung cancer radiation therapy and the preventive role of positron-emission tomography

Authors

  • O. Yu. Stoliarova National Cancer Institute of Health Ministry of Ukraine, Kyiv,
  • Yu. V. Dumanskyi Donetsk National Medical University of Health Ministry of Ukraine, Lyman,
  • O. V. Syniachenko Donetsk National Medical University of Health Ministry of Ukraine, Lyman,
  • Ye. D. Yehudina SI “Dnepropetrovsk Medical Academy of Health Ministry of Ukraine”, Dnipro,
  • O. O. Khaniukov SI “Dnepropetrovsk Medical Academy of Health Ministry of Ukraine”, Dnipro,

DOI:

https://doi.org/10.14739/2310-1210.2018.1.121995

Keywords:

cancer of lungs, radiation therapy, positron-emission tomography

Abstract

Timely radiation therapy (RT) has become the basis for increasing the effectiveness of patients with lung cancer (LC) treatment and survival. RT is currently being used for most of such patients, although there are no reliable criteria to predict the effectiveness of radiotherapy at the moment. A large number of serious complications of radiation therapy require its improvement. Recently, the importance of positron emission tomography (PET) for LC visualization and monitoring of treatment results has been considered, as well as for the elucidation of the optimal format in the process of RT planning.

The purpose of study: to investigate the nature of the RT complications in various options of the LC course, to identify the risk factors and to assess the role of the preliminary PET with fluoride-dehydroglucose in order to reduce the number of side effects of irradiation.

Materials and methods. 1071 patients with LC at the ages from 24 to 86 years (mean age 59 years) were observed (83 % of men and 17 % of women). None of the patients with LC has been previously operated. The central form of LC was noted in 79 % of the examined, peripheral – in 21 %, small cell histological variant – in 18 % of cases, and non-small cell – in 82 %, IIIA–IV stages were detected in 95 % of patients’ number. 33 % of patients received radical radiation therapy for the primary tumor, 53 % – palliative lung irradiation, 14 % – palliative radiotherapy of distant metastases. A group of 25 LC patients was formed who were RT planned with the help of PET/CT (computed tomography). The ratio of upper lobe, middle lobe, middle upper, lower lobe, middle lower and mediastinal localization was 7:6:5:4:2:1, non-small cell forms of LC were noted in ¾ of the patients’ number, and small-cell forms in ¼, the ratio of IIIA, IIIB and IV disease stages was 4:4:3. The cyclotron "Siemens-RDS-Eclipse-RD" (Germany), combined tomograph PET/CT "Biograph-64-TruePoint-Siemens (Germany) were used.

Results. The side effects of radiation therapy were identified in 23 % of LC cases (22 % men and 32 % women). Among the main complications of LC it has been found (in descending order): myelodepression, pulmonary hypertension, acute radiation pneumonitis, hemoptysis, acute vascular insufficiency, radiation esophagitis, acute coronary syndrome, pulmonary fibrosis, acute cerebrovascular accident, pulmonary edema, thromboembolism of the pulmonary artery branches. The integral nature of the radiotherapy complications is associated with radiotherapy for primary tumor and palliative for distant metastases, has sexual dimorphism (radiation pneumofibrosis, esophagitis, acute vascular insufficiency, pulmonary edema) and is determined by the irradiation power (development of myelodepression, radiation esophagitis). The use of a metabolic image in PET/CT allowed us to specify the area of irradiation by including a peritumorous zone in the target. It has significantly increased the carcinocidal effect of radiation in all patients and ensured a higher survival rate of patients, avoiding cases of acute radiation pneumonitis, esophagitis and pulmonary fibrosis.

Conclusions. The integral nature of the radiochemotherapy complications in LC is observed practically in every fourth patient with LC, it is associated with radical RT for the primary tumor and palliative for distant metastases, has gender specific features and is determined by the irradiation rate. PET/CT provides an increase in the radiation exposure effectiveness with a decrease in its effects on healthy lung tissue, and as the result the incidence of RT side effects is reduced.

References

Fan, X., Jia, C., Yang, J., Li, G., Mao, H., Jin, Q., & Zhao, J. (2015). A microfluidic chip integrated with a high-density PDMS-based microfiltration membrane for rapid isolation and detection of circulating tumor cells. Biosens Bioelectron, 71(15), 380–386. doi: 10.1016/j.bios.2015.04.080.

Chen, X., Kong, X., Zhang, Z., Chen, W., Chen, J., Li, H., et al. (2014). Alpha-2-macroglobulin as a radioprotective agent: a review. Chin J Cancer Res, 26(5), 611–621. doi: 10.3978/j.issn.1000-9604.2014.09.04.

Datta, N. R., Samiei, M., & Bodis, S. (2014). Radiotherapy infrastructure and human resources in Europe – present status and its implications for 2020. Eur J Cancer, 50(15), 2735–2743. doi: 10.1016/j.ejca.2014.06.012.

Ricardi, U., Badellino, S., & Filippi, A. R. (2015). Stereotactic radiotherapy for early stage non-small cell lung cancer. Radiat Oncol J, 33(2), 57–65. doi: 10.3857/roj.2015.33.2.57.

Zhang, H., Xia, H., Zhang, L., Zhang, B., Yue, D., & Wang, C. (2015). Clinical significance of preoperative neutrophil-lymphocyte vs platelet-lymphocyte ratio in primary operable patients with non-small cell lung cancer. Am J Surg, 210(3), 526–35. doi: 10.1016/j.amjsurg.2015.03.022.

Wallerek, S., & Sørensen, J. B. (2015) Biomarkers for efficacy of adjuvant chemotherapy following complete resection in NSCLC stages I-IIIA. Eur Respir Rev, 24(136), 340–355. doi: 10.1183/16000617.00005814.

Oh, J. H., Craft, J. M. Townsend, R., Deasy, J. O., Bradley, J. D., & El Naqa, I. (2011) A bioinformatics approach for biomarker identification in radiation-induced lung inflammation from limited proteomics data. J Proteome Res, 10(3), 1406–1415. doi: 10.1021/pr101226q.

Pollock, S., O'Brien, R., & Makhija, K. (2015). Audiovisual biofeedback breathing guidance for lung cancer patients receiving radiotherapy: a multi-institutional phase II randomised clinical trial. BMC Cancer, 18(15), 526–536. doi: 10.1186/s12885-015-1483-7.

Khalil, A. A., Hoffmann, L., Moeller, D. S., Farr, K. P., & Knap, M. M. (2015) New dose constraint reduces radiation-induced fatal pneumonitis in locally advanced non-small cell lung cancer patients treated with intensity-modulated radiotherapy. Acta Oncol, 54(9), 1343–9. doi: 10.3109/0284186X.2015.1061216.

Neal, J. W., Gainor, J. F., & Shaw, A. T. (2015). Developing biomarker-specific аnd points in lung cancer clinical trials. Nat Rev Clin Oncol, 12(3), 135–146. doi: 10.1038/nrclinonc.2014.222.

Xie, D., Marks, R., Zhang, M., Jiang, G., Jatoi, A., Garces, Y., et al. (2015). Nomograms predict overall survival for patients with small-cell lung cancer incorporating pretreatment peripheral blood markers. J Thorac Oncol, 10(8), 1213–1220. doi: 10.1097/JTO.0000000000000585.

Erak, M. D., Mitrić, M., Djuran, B., Tesanović, D., & Vasiljev, S. (2016). PET/CT fusion in radiotherapy planning for lung cancer – Case reports. Vojnosanit Pregl, 73(6), 599–602. doi: 10.2298/VSP140602051E.

Prathipati, A., Manthri, R. G., Subramanian, B. V., Das, P., Jilla, S., Mani, S., et al. (2017). A prospective study comparing functional imaging (18F-FDG PET) versus anatomical imaging (Contrast Enhanced CT) in dosimetric planning for non-small cell lung cancer. Asia Ocean J Nucl Med Biol, 5(2), 75–84. doi: 10.22038/aojnmb.2017.8706.

De Ruysscher, D., Faivre-Finn, C., Moeller, D., Nestle, U., Hurkmans, C. W., Le Péchoux, C., et al. (2017). European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer. Radiother Oncol, 124(1), 1–10. doi: 10.1016/j.radonc.2017.06.003.

Riegler, G., Karanikas, G., Rausch, I., Hirtl, A., El-Rabadi, K., Marik, W., et al. (2017). Influence of PET reconstruction technique and matrix size on qualitative and quantitative assessment of lung lesions on [18F]-FDG-PET: A prospective study in 37 cancer patients. Eur J Radiol, 90(5), 20–26. doi: 10.1016/j.ejrad.2017.02.023.

Ashley Cox, R., Akhurst, T., Bressel, M., MacManus, M., & Ball, D. (2017). Survival and central photopenia detected by fluorine-18 fluoro-deoxy-glucose positron emission tomography (FDG-PET) in patients with locoregional non-small cell lung cancer treated with radiotherapy. Radiother Oncol, 124(1), 25–30. doi: 10.1016/j.radonc.2017.06.004.

Everitt, S., Callahan, J. Obeid, E., Hicks, R. J., Mac Manus, M., & Ball, D. (2017). Acute radiation oesophagitis associated with 2-deoxy-2-[18F]fluoro-d-glucose uptake on positron emission tomography/CT during chemo-radiation therapy in patients with non-small-cell lung cancer. J Med Imaging Radiat Oncol, 61(5), 682–688. doi: 10.1111/1754-9485.12631.

Chang, J. Y. (2015). Intensity-modulated radiotherapy, not 3 dimensional conformal, is the preferred technique for treating locally advanced lung cancer. Semin Radiat Oncol, 25(2), 110–116. doi: 10.1016/j.semradonc.2014.11.002.

Kong, F. M., & Wang, S. (2015). Nondosimetric risk factors for radiation-induced lung toxicity. Semin Radiat Oncol, 25(2), 100–109. doi: 10.1016/j.semradonc.2014.12.003.

Slotman, B. J., & van Tinteren, H. (2015) Which patients with extensive stage small-cell lung cancer should and should not receive thoracic radiotherapy? Transl Lung Cancer Res, 4(3), 292–294. doi: 10.3978/j.issn.2218-6751.2015.04.07.

Siva, S., Callahan, J., Kron, T., Martin, O. A., MacManus, M. P., Ball, D. L., et al. (2014). A prospective observational study of Gallium-68 ventilation and perfusion PET/CT during and after radiotherapy in patients with non-small cell lung cancer. BMC Cancer, 14(2), 740–750. doi: 10.1186/1471-2407-14-740.

Downloads

How to Cite

1.
Stoliarova OY, Dumanskyi YV, Syniachenko OV, Yehudina YD, Khaniukov OO. Complications of lung cancer radiation therapy and the preventive role of positron-emission tomography. Zaporozhye Medical Journal [Internet]. 2018Jan.31 [cited 2024May8];(1). Available from: http://zmj.zsmu.edu.ua/article/view/121995

Issue

No. 1 (2018)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)