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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2022.1538    [Accepted]
Predictors of Post-Chemoradiotherapy Pulmonary Complication in Locally Advanced Non-Small Cell Lung Cancer
Tae Hoon Lee1 , Byung-Hee Kang2 , Hak Jae Kim1,3, Hong-Gyun Wu1,3, Joo Ho Lee1,3
1Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
2Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
3Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
Correspondence  Joo Ho Lee ,Tel: 82-2-2072-2819, Fax: 82-2-765-3317, Email: jooholee@snu.ac.kr
Received: November 22, 2022;  Accepted: January 18, 2023.  Published online: January 19, 2023.
*Tae Hoon Lee and Byung-Hee Kang contributed equally to this work.
We investigated the clinical effects and predictive factors of severe post-chemoradiotherapy pulmonary complications (PCPC) in locally advanced non-small cell lung cancer (LA-NSCLC).
Materials and Methods
Medical records of 317 patients who underwent definitive concurrent chemoradiation (CCRT) for LA-NSCLC were reviewed retrospectively. PCPC was defined as an event of admission or emergency department visit for acute or subacute pulmonary inflammatory complications, including pneumonitis and pneumonia, within 6 months after CCRT initiation. Patient characteristics, baseline lung function tests, radiation dosimetric parameters, and laboratory tests were analysed to investigate their association with PCPC. Prognostic endpoints were disease progression rate (DPR) and overall survival (OS).
PCPC was reported in 53 (16.7%) patients. The OS of patients with PCPC was significantly worse (35.0% in 2 years) than that of patients without PCPC (67.0% in 2 years, p<0.001). However, 2-year DPRs were 77.0% and 70.7% in patients with and without PCPC, respectively, which were not significantly different (p=0.087). In multivariate logistic regression, PCPC was independently associated with grade≥1 hypoalbuminaemia during CCRT (odds ratio [OR] 5.670, 95% confidence interval [CI] 2.487–13.40, p<0.001), lower diffusing capacity of carbon monoxide (DLCO) (per ml/min/mmHg, OR 0.855, 95% CI 0.743–0.974, p=0.022), and higher lung V5 (per 10%, OR 1.872, 95% CI 1.336–2.699, p<0.001).
PCPC might be a clinical endpoint to evaluate complications and predict the survival of patients subjected to CCRT for LA-NSCLC. Hypoalbuminaemia, DLCO, and lung V5 might predict PCPC in LA-NSCLC.
Key words: Lung neoplasms, Chemoradiotherapy, Hypoalbuminaemia, Pulmonary diffusing capacity
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