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Objective: To predict the risk factors of radiation pneumonitis (RP) in patients with esophageal squamous cell carcinoma (ESCC) who received radiotherapy. Methods: From January 2015 to October 2021, 477 ESCC patients were enrolled and were assessed retrospectively. All these patients received radiotherapy for primary lesions or mediastinal metastatic lymph nodes. Clinical efficacy and adverse events (AEs) were observed. Univariate analysis identified clinical and dosimetric factors associated with the development of RP, and multivariate logistic regression analysis identified independent potential risk factors associated with the development of RP. Nomograms were constructed to predict RP based on the results of multivariate logistic regression analysis. Results: Among the 477 ESCC patients, the incidence of RP was 22.2%, and the incidence of grade 4 or higher RP was 1.5%. Univariate analysis indicated that chronic obstructive pulmonary disease (COPD), pulmonary infection, leucopenia, PTV volume, V5, V20, V30 andMLD affected the occurrence of RP. Themultivariate logistic regression analysis indicated that COPD (OR:1.821, 95%CI:1.111-2.985; P=0.017), pulmonary infection (OR:2.528, 95%CI:1.530-4.177; P<0.001), higher V20 (OR: 1.129, 95% CI:1.006-1.266; P=0.029) were significant independent predictors of RP in ESCC patients. COPD, pulmonary infection, V20 have been integrated for the RP nomogram. The rate of RP was significantly reduced in the V20<21.45% group. Further analysis indicated that the old age, diabetes, higher V20, and higherMLD were risk factors for grade 4 or higher RP. The area under the curve (AUC) value for V20 was 0.73 (95% CI, 0.567-0.893, P < 0.05). Conclusion: We have determined the risk factors of RP and grade 4 or higher RP in ESCC patients after radiotherapy. MLD, V20, COPD were independent factors for RP. It was necessary to take measures to reduce or avoid the occurrence of RP for patients with these risk factors at the early stage. [ABSTRACT FROM AUTHOR]

Objective:Some previous studies have shown that low-dose radiotherapy (RT) can increase tumor invasion and metastasis. Multiple RT fields are usually used to prevent the damage to the organs at risk. We performed a clinical study with a concern that low-dose RT might increase invasion or metastasis. Ionizing radiation (IR) can enhance the potential tumor micro-environment by modifying the host micro-metastatic cancer cells.Methods:We conducted a retrospective study on 50 patients aged between 45 and 87 years, who were applied RT and/or chemotherapy, had the Eastern Cooperative Oncology Group performance status (ECOG) between 1 and 3 and stage II–III lung cancer, and were without any metastasis. RT was applied at daily fractions of 180–200 cGy (5 days/week) and a 54–66 Gy total dose. V5, V10, V20, V40, V50, and V60 values of the lung in a disease-free life, and general life effects statistically analysed with Mann-Whitney U and L Par testS.Results:A lower RT dose range, which produced V5, V10, and V20 volume values of the lung, was analyzed. It was observed that the V5, V10, and V20 RT volumes of the lung provided a minimal positive effect on relapse-free and general survival according to the R-correlation values.Conclusion:Larger studies are necessary according to these results to evaluate the impact of low-dose radiation and to increase the survival rates.

Summary: Introduction Durvalumab has been shown to confer a survival benefit after definitive chemoradiotherapy in the patients with locally advanced non-small cell lung cancer, but no studies have attempted to identify risk factors for pneumonitis after durvalumab therapy. The purpose of this study was to investigate associations between clinical and radiation dose-volume factors, and the severity of pneumonitis. Methods We retrospectively assessed the cases of 30 patients who had been started on durvalumab therapy between July 2018 and February 2019. In this study we evaluated the percentage of lung volume receiving radiation dose in excess of 20 Gy (V20) as radiation dose-volume factor. We compared V20 and some baseline factors between a grade 0 or 1 (Gr 0/1) pneumonitis group and a grade 2 or more (≥Gr 2) pneumonitis group, and we performed a logistic regression analysis to establish the associations between variables and ≥ Gr 2 pneumonitis. Results Pneumonitis had developed in 22 patients (73.3%): Gr 1/2/3–5 in 8 (26.7%)/14 (46.7%) /0 (0%), respectively. The difference in V20 between the Gr 0/1 group and Gr 2 group (median: 20.5% vs. 23.5%, p = 0.505) was not statistically significant, and thus V20 was not a risk factor for Gr 2 pneumonitis (odds ratio: 1.047, p = 0.303). None of the clinical factors, including sex, age, smoking history, presence of baseline pneumonitis, type of radiation therapy, location of lesion and facility, were risk factors. Conclusions Our study suggest that the severity of pneumonitis after durvalumab is unrelated to V20 or any of the clinical factors assessed in this study. [ABSTRACT FROM AUTHOR]

Abstract Objective Several studies have shown that low‐dose radiotherapy (RT) might increase tumor invasion and metastases. Whereas multiple RT fields that increase low‐dose RT areas are often used to prevent damage to organs at risk. We carried out a clinical trial with the concern that low‐dose RT sites could increase invasions or metastases when multiple sites were used. Methods A clinical retrospective study was carried out on 50 lung cancer patients with stage II–IIIB cancer, who underwent RT and/or chemotherapy, had Eastern Cooperative Oncology Group performances 1–3, were aged 45–87 years, and without metastases. RT was carried out for 5 days with 180–200 cGy fractions per day with a total dose of 54–66 Gy. The radiation dose volume areas V5, V10, V20, V40, V50, and V60 of lung were calculated and analyzed by Mann–Whitney U‐test and L par test on disease‐free and overall survival statistically. Results It was determined that V5, V10, and V20, which constitute the low RT dose areas of the lung, positively affected the recurrence‐free and overall survival minimally according to r correlation values. Conclusion Low‐dose RT volumes were positively affected minimally by recurrence‐free survival and overall survival in the present study. The effects of low‐dose radiation must be evaluated more clearly in studies.

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Objective: Several studies have shown that low‐dose radiotherapy (RT) might increase tumor invasion and metastases. Whereas multiple RT fields that increase low‐dose RT areas are often used to prevent damage to organs at risk. We carried out a clinical trial with the concern that low‐dose RT sites could increase invasions or metastases when multiple sites were used. Methods: A clinical retrospective study was carried out on 50 lung cancer patients with stage II–IIIB cancer, who underwent RT and/or chemotherapy, had Eastern Cooperative Oncology Group performances 1–3, were aged 45–87 years, and without metastases. RT was carried out for 5 days with 180–200 cGy fractions per day with a total dose of 54–66 Gy. The radiation dose volume areas V5, V10, V20, V40, V50, and V60 of lung were calculated and analyzed by Mann–Whitney U‐test and L par test on disease‐free and overall survival statistically. Results: It was determined that V5, V10, and V20, which constitute the low RT dose areas of the lung, positively affected the recurrence‐free and overall survival minimally according to r correlation values. Conclusion: Low‐dose RT volumes were positively affected minimally by recurrence‐free survival and overall survival in the present study. The effects of low‐dose radiation must be evaluated more clearly in studies. [ABSTRACT FROM AUTHOR]

Abstract: Dosimetric studies on respiratory movement suggest several advantages toward the use of 4-dimensional computed tomography (4DCT) in radiation treatment planning. 4DCT is a method to obtain a series of CT scans each representing a different respiratory phase. The use of 4DCT has provided substantial information on tumor movement in the lung, allowing for the creation of custom planning margins explicitly including respiratory motion. These custom motion margins may result in an increase in the amount of normal lung in the field; however, it is believed less normal lung is irradiated than if generic motion margins were used. Clinical data regarding dose to normal lung by using 4DCT remain rather limited. Thus, a study presenting figures on the change in normal lung dose between planned free breathing CT and 4DCT cases would be useful to the dosimetry community. We have generated plans comparing fast spiral CT and 4DCT in regard to tumor coverage and the resulting dose to normal lung for the clinical target volume (CTV) and planning target volume (PTV) expansions used at our institution. These data were analyzed for free breathing and 4D plans of 6 lung cancer patients using intensity modulated radiation therapy (IMRT). We compared doses to normal lung tissue between free breathing and 4DCT plans. [Copyright &y& Elsevier]

Purpose: To test the hypothesis that the volume of pelvic bone marrow (PBM) receiving 10 and 20 Gy or more (PBM-V10 and PBM-V20) is associated with acute hematologic toxicity (HT) in anal cancer patients treated with concurrent chemoradiotherapy. Methods and Materials: We analyzed 48 consecutive anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiation therapy. The median radiation dose to gross tumor and regional lymph nodes was 50.4 and 45 Gy, respectively. Pelvic bone marrow was defined as the region extending from the iliac crests to the ischial tuberosities, including the os coxae, lumbosacral spine, and proximal femora. Endpoints included the white blood cell count (WBC), absolute neutrophil count (ANC), hemoglobin, and platelet count nadirs. Regression models with multiple independent predictors were used to test associations between dosimetric parameters and HT. Results: Twenty patients (42%) had Stage T3–4 disease; 15 patients (31%) were node positive. Overall, 27 (56%), 24 (50%), 4 (8%), and 13 (27%) experienced acute Grade 3–4 leukopenia, neutropenia, anemia, and thrombocytopenia, respectively. On multiple regression analysis, increased PBM-V5, V10, V15, and V20 were significantly associated with decreased WBC and ANC nadirs, as were female gender, decreased body mass index, and increased lumbosacral bone marrow V10, V15, and V20 (p < 0.05 for each association). Lymph node positivity was significantly associated with a decreased WBC nadir on multiple regression analysis (p < 0.05). Conclusion: This analysis supports the hypothesis that increased low-dose radiation to PBM is associated with acute HT during chemoradiotherapy for anal cancer. Techniques to limit bone marrow irradiation may reduce HT in anal cancer patients. [Copyright &y& Elsevier]

: Purpose:To examine the ability of standard dose–volume metrics to predict pulmonary function changes as measured by pulmonary function tests (PFTs) in a group of patients with non–small-cell lung cancer treated with nonconventional beam arrangements on a Phase I dose-escalation study. In addition, we wanted to examine the correlation between these metrics.: Methods and materials:Forty-three patients received a median treatment dose of 76.9 Gy (range 63–102.9). Eight patients also received induction chemotherapy with cisplatin and vinorelbine. They all had pre- and posttreatment PFTs ≥3 months (median 6.2) after treatment. The volume of normal lung treated to >20 Gy, effective volume, and mean lung dose were calculated for both lungs for all patients. Linear regression analysis was performed to determine whether correlations existed between the metrics and changes in the PFTs. Additionally, the three metrics were compared with each other to assess the degree of intermetric correlation.: Results:No correlation was found between the volume of normal lung treated to >20 Gy, effective volume, and mean lung dose and changes in the PFTs. Subgroup analyses of patients without atelectasis before irradiation, Stage I and II disease, or treatment without induction chemotherapy were also performed. Again, no correlation was found between the dose–volume metrics and the PFT changes. The intermetric correlation was good among all three dose–volume metrics.: Conclusion:In this relatively small series of patients, dose–volume metrics that correlate with the risk of pneumonitis did not provide a good model to predict early changes in pulmonary function as measured with PFTs. [Copyright &y& Elsevier]

Introduction: Although chemoradiotherapy for locally advanced lung cancer has the potential for cure, treatment is avoided in patients with interstitial lung disease because of the risk for severe radiation pneumonitis. Interstitial lung abnormalities (ILA) can be evaluated using high-resolution computed tomography (HRCT) to assess interstitial changes. In this study, we retrospectively examined the feasibility and efficacy of chemoradiotherapy for locally advanced lung cancer patients with ILA., Methods: Patients who underwent chemoradiotherapy for locally advanced lung cancer at Okayama University Hospital between 2012 and 2015 were reviewed retrospectively. HRCT prior to treatment was evaluated by one pulmonologist and two radiologists using a sequential reading method., Results: Of the 77 patients enrolled in this study, ILA was present in 25 (32.5%) and indeterminate ILA in 24 patients; 28 patients did not have ILA. Desaturation at rest (SpO2 < 95%) and honeycombing on HRCT were not observed in ILA patients. Only one patient with ILA had a low vital capacity (%VC < 80%). Severe radiation pneumonitis (≥Grade 2) occurred in 36.0% of the patients with ILA, but it was controllable; Grade 4 or 5 was not observed. Multivariate analysis showed that >25% of the lung volume receiving >20 Gy was risk factors of severe radiation pneumonitis, but ILA was not. The 2-year survival rates of patients with and without ILA were 56.8% and 74.1%, respectively, but the difference was not significant (P = 0.33)., Conclusions: Chemoradiotherapy was feasible and effective in some patient population with ILA without desaturation, low VC and honeycombing on HRCT., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The purpose was to evaluate the predictive value of baseline neutrophil to lymphocyte ratio (NLR) level in the incidence of grade 3 or higher radiation induced lung injury (RILI) for lung cancer patients. A retrospectively analysis with 166 lung cancer patients was performed. All of the enrolled patients received chemoradiotherapy at our hospital between April 2014 and May 2016. The Cox proportional hazard model was used to identify the potential risk factors for RILI. In this cohort, the incidence of grade 3 or higher RILI was 23.8%. Univariate analysis showed that radiation dose, volume at least received 20Gy (V20), mean lung dose and NLR were significantly associated with the incidence of grade 3 or higher RILI ( P = 0.012, 0.008, 0.012, and 0.039, respectively). Multivariate analysis revealed that total dose ≥ 60 Gy, V20 ≥ 20%, mean lung dose ≥ 12 Gy, and NLR ≥ 2.2 were still independent predictive factors for RILI ( P = 0.010, 0.043, 0.028, and 0.015, respectively). A predictive model of RILI based on the identified risk factors was established using receiver operator characteristic curves. The results demonstrated that the combination analysis of V20, mean lung dose and NLR was superior to either of the variables alone. Additionally, we found that the constraint of V20 and mean lung dose were meaningful for patients with higher baseline NLR level. If the value of V20 and mean lung dose lower than the threshold value, the incidence of grade 3 or higher RILI for the high NLR level patients could be decreased from 63.3% to 8.7%. Our study showed that radiation dose, V20, mean lung dose and NLR were independent predictors for RILI. Combination analysis of V20, mean lung dose and NLR may provide a more accurate model for RILI prediction., Competing Interests: CONFLICTS OF INTEREST The authors declare no conflicts of interest.