Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-hodgkin lymphoma

Chelsea C. Pinnix; Grace L. Smith; Sarah Milgrom; Eleanor M. Osborne; Jay P. Reddy; Mani Akhtari; Valerie Reed; Isidora Arzu; Pamela K. Allen; Christine F. Wogan; Michele A. Fanale; Yasuhiro Oki; Francesco Turturro; Jorge Romaguera; Luis Fayad; Nathan Fowler; Jason Westin; Loretta Nastoupil; Fredrick B. Hagemeister; M. Alma Rodriguez; Sairah Ahmed; Yago Nieto; Bouthaina Dabaja

doi:10.1016/j.ijrobp.2015.02.010

Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-hodgkin lymphoma

Chelsea C. Pinnix, Grace L. Smith, Sarah Milgrom, Eleanor M. Osborne, Jay P. Reddy, Mani Akhtari, Valerie Reed, Isidora Arzu, Pamela K. Allen, Christine F. Wogan, Michele A. Fanale, Yasuhiro Oki, Francesco Turturro, Jorge Romaguera, Luis Fayad, Nathan Fowler, Jason Westin, Loretta Nastoupil, Fredrick B. Hagemeister, M. Alma RodriguezSairah Ahmed, Yago Nieto, Bouthaina Dabaja

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Abstract

Purpose Few studies to date have evaluated factors associated with the development of radiation pneumonitis (RP) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), especially in patients treated with contemporary radiation techniques. These patients represent a unique group owing to the often large radiation target volumes within the mediastinum and to the potential to receive several lines of chemotherapy that add to pulmonary toxicity for relapsed or refractory disease. Our objective was to determine the incidence and clinical and dosimetric risk factors associated with RP in lymphoma patients treated with intensity modulated radiation therapy (IMRT) at a single institution. Methods and Materials We retrospectively reviewed clinical charts and radiation records of 150 consecutive patients who received mediastinal IMRT for HL and NHL from 2009 through 2013. Clinical and dosimetric predictors associated with RP according to Radiation Therapy Oncology Group (RTOG) acute toxicity criteria were identified in univariate analysis using the Pearson χ² test and logistic multivariate regression. Results Mediastinal radiation was administered as consolidation therapy in 110 patients with newly diagnosed HL or NHL and in 40 patients with relapsed or refractory disease. The overall incidence of RP (RTOG grades 1-3) was 14% in the entire cohort. Risk of RP was increased for patients who received radiation for relapsed or refractory disease (25%) versus those who received consolidation therapy (10%, P=.019). Several dosimetric parameters predicted RP, including mean lung dose of >13.5 Gy, V₂₀ of >30%, V₁₅ of >35%, V₁₀ of >40%, and V₅ of >55%. The likelihood ratio χ² value was highest for V₅ >55% (χ² = 19.37). Conclusions In using IMRT to treat mediastinal lymphoma, all dosimetric parameters predicted RP, although small doses to large volumes of lung had the greatest influence. Patients with relapsed or refractory lymphoma who received salvage chemotherapy and hematopoietic stem cell transplantation were at higher risk for symptomatic RP.

Original language	English (US)
Pages (from-to)	175-182
Number of pages	8
Journal	International Journal of Radiation Oncology Biology Physics
Volume	92
Issue number	1
DOIs	https://doi.org/10.1016/j.ijrobp.2015.02.010
State	Published - May 1 2015

ASJC Scopus subject areas

Radiation
Oncology
Radiology Nuclear Medicine and imaging
Cancer Research

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Pinnix, C. C., Smith, G. L., Milgrom, S., Osborne, E. M., Reddy, J. P., Akhtari, M., Reed, V., Arzu, I., Allen, P. K., Wogan, C. F., Fanale, M. A., Oki, Y., Turturro, F., Romaguera, J., Fayad, L., Fowler, N., Westin, J., Nastoupil, L., Hagemeister, F. B., ... Dabaja, B. (2015). Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-hodgkin lymphoma. International Journal of Radiation Oncology Biology Physics, 92(1), 175-182. https://doi.org/10.1016/j.ijrobp.2015.02.010

Pinnix, CC , Smith, GL, Milgrom, S, Osborne, EM, Reddy, JP, Akhtari, M, Reed, V , Arzu, I, Allen, PK, Wogan, CF, Fanale, MA, Oki, Y, Turturro, F, Romaguera, J, Fayad, L, Fowler, N, Westin, J , Nastoupil, L, Hagemeister, FB, Rodriguez, MA, Ahmed, S , Nieto, Y & Dabaja, B 2015, 'Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-hodgkin lymphoma', International Journal of Radiation Oncology Biology Physics, vol. 92, no. 1, pp. 175-182. https://doi.org/10.1016/j.ijrobp.2015.02.010

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title = "Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-hodgkin lymphoma",

abstract = "Purpose Few studies to date have evaluated factors associated with the development of radiation pneumonitis (RP) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), especially in patients treated with contemporary radiation techniques. These patients represent a unique group owing to the often large radiation target volumes within the mediastinum and to the potential to receive several lines of chemotherapy that add to pulmonary toxicity for relapsed or refractory disease. Our objective was to determine the incidence and clinical and dosimetric risk factors associated with RP in lymphoma patients treated with intensity modulated radiation therapy (IMRT) at a single institution. Methods and Materials We retrospectively reviewed clinical charts and radiation records of 150 consecutive patients who received mediastinal IMRT for HL and NHL from 2009 through 2013. Clinical and dosimetric predictors associated with RP according to Radiation Therapy Oncology Group (RTOG) acute toxicity criteria were identified in univariate analysis using the Pearson χ2 test and logistic multivariate regression. Results Mediastinal radiation was administered as consolidation therapy in 110 patients with newly diagnosed HL or NHL and in 40 patients with relapsed or refractory disease. The overall incidence of RP (RTOG grades 1-3) was 14% in the entire cohort. Risk of RP was increased for patients who received radiation for relapsed or refractory disease (25%) versus those who received consolidation therapy (10%, P=.019). Several dosimetric parameters predicted RP, including mean lung dose of >13.5 Gy, V20 of >30%, V15 of >35%, V10 of >40%, and V5 of >55%. The likelihood ratio χ2 value was highest for V5 >55% (χ2 = 19.37). Conclusions In using IMRT to treat mediastinal lymphoma, all dosimetric parameters predicted RP, although small doses to large volumes of lung had the greatest influence. Patients with relapsed or refractory lymphoma who received salvage chemotherapy and hematopoietic stem cell transplantation were at higher risk for symptomatic RP.",

author = "Pinnix, {Chelsea C.} and Smith, {Grace L.} and Sarah Milgrom and Osborne, {Eleanor M.} and Reddy, {Jay P.} and Mani Akhtari and Valerie Reed and Isidora Arzu and Allen, {Pamela K.} and Wogan, {Christine F.} and Fanale, {Michele A.} and Yasuhiro Oki and Francesco Turturro and Jorge Romaguera and Luis Fayad and Nathan Fowler and Jason Westin and Loretta Nastoupil and Hagemeister, {Fredrick B.} and Rodriguez, {M. Alma} and Sairah Ahmed and Yago Nieto and Bouthaina Dabaja",

note = "Publisher Copyright: {\textcopyright} 2015 The Authors.",

year = "2015",

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doi = "10.1016/j.ijrobp.2015.02.010",

language = "English (US)",

volume = "92",

pages = "175--182",

journal = "International Journal of Radiation Oncology Biology Physics",

issn = "0360-3016",

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TY - JOUR

T1 - Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-hodgkin lymphoma

AU - Pinnix, Chelsea C.

AU - Smith, Grace L.

AU - Milgrom, Sarah

AU - Osborne, Eleanor M.

AU - Reddy, Jay P.

AU - Akhtari, Mani

AU - Reed, Valerie

AU - Arzu, Isidora

AU - Allen, Pamela K.

AU - Wogan, Christine F.

AU - Fanale, Michele A.

AU - Oki, Yasuhiro

AU - Turturro, Francesco

AU - Romaguera, Jorge

AU - Fayad, Luis

AU - Fowler, Nathan

AU - Westin, Jason

AU - Nastoupil, Loretta

AU - Hagemeister, Fredrick B.

AU - Rodriguez, M. Alma

AU - Ahmed, Sairah

AU - Nieto, Yago

AU - Dabaja, Bouthaina

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Purpose Few studies to date have evaluated factors associated with the development of radiation pneumonitis (RP) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), especially in patients treated with contemporary radiation techniques. These patients represent a unique group owing to the often large radiation target volumes within the mediastinum and to the potential to receive several lines of chemotherapy that add to pulmonary toxicity for relapsed or refractory disease. Our objective was to determine the incidence and clinical and dosimetric risk factors associated with RP in lymphoma patients treated with intensity modulated radiation therapy (IMRT) at a single institution. Methods and Materials We retrospectively reviewed clinical charts and radiation records of 150 consecutive patients who received mediastinal IMRT for HL and NHL from 2009 through 2013. Clinical and dosimetric predictors associated with RP according to Radiation Therapy Oncology Group (RTOG) acute toxicity criteria were identified in univariate analysis using the Pearson χ2 test and logistic multivariate regression. Results Mediastinal radiation was administered as consolidation therapy in 110 patients with newly diagnosed HL or NHL and in 40 patients with relapsed or refractory disease. The overall incidence of RP (RTOG grades 1-3) was 14% in the entire cohort. Risk of RP was increased for patients who received radiation for relapsed or refractory disease (25%) versus those who received consolidation therapy (10%, P=.019). Several dosimetric parameters predicted RP, including mean lung dose of >13.5 Gy, V20 of >30%, V15 of >35%, V10 of >40%, and V5 of >55%. The likelihood ratio χ2 value was highest for V5 >55% (χ2 = 19.37). Conclusions In using IMRT to treat mediastinal lymphoma, all dosimetric parameters predicted RP, although small doses to large volumes of lung had the greatest influence. Patients with relapsed or refractory lymphoma who received salvage chemotherapy and hematopoietic stem cell transplantation were at higher risk for symptomatic RP.

AB - Purpose Few studies to date have evaluated factors associated with the development of radiation pneumonitis (RP) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), especially in patients treated with contemporary radiation techniques. These patients represent a unique group owing to the often large radiation target volumes within the mediastinum and to the potential to receive several lines of chemotherapy that add to pulmonary toxicity for relapsed or refractory disease. Our objective was to determine the incidence and clinical and dosimetric risk factors associated with RP in lymphoma patients treated with intensity modulated radiation therapy (IMRT) at a single institution. Methods and Materials We retrospectively reviewed clinical charts and radiation records of 150 consecutive patients who received mediastinal IMRT for HL and NHL from 2009 through 2013. Clinical and dosimetric predictors associated with RP according to Radiation Therapy Oncology Group (RTOG) acute toxicity criteria were identified in univariate analysis using the Pearson χ2 test and logistic multivariate regression. Results Mediastinal radiation was administered as consolidation therapy in 110 patients with newly diagnosed HL or NHL and in 40 patients with relapsed or refractory disease. The overall incidence of RP (RTOG grades 1-3) was 14% in the entire cohort. Risk of RP was increased for patients who received radiation for relapsed or refractory disease (25%) versus those who received consolidation therapy (10%, P=.019). Several dosimetric parameters predicted RP, including mean lung dose of >13.5 Gy, V20 of >30%, V15 of >35%, V10 of >40%, and V5 of >55%. The likelihood ratio χ2 value was highest for V5 >55% (χ2 = 19.37). Conclusions In using IMRT to treat mediastinal lymphoma, all dosimetric parameters predicted RP, although small doses to large volumes of lung had the greatest influence. Patients with relapsed or refractory lymphoma who received salvage chemotherapy and hematopoietic stem cell transplantation were at higher risk for symptomatic RP.

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Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-hodgkin lymphoma

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