P2.16-18 Study of Interstitial Lung Disease and Acute Exacerbation in Patients Receiving Radiation Therapy for Lung Cancer in Japan

JOURNAL OF THORACIC ONCOLOGY(2018)

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摘要
Radiation therapy (RT) for lung cancer in patients who have interstitial lung disease (ILD) is considered to be a risk for acute exacerbation (AE). The indication for RT in such patients is determined in each facility. The ratio of patients with ILD who have received RT for lung cancer, the incidence of AE in such patients, and the risk factors for AE are unclear. To clarify these, a nationwide survey was carried out by the Lung and Mediastinal Tumor Committee of the Japan Radiation Oncology Study Group (JROSG). (1) Questionnaire survey on the diagnosis of ILD, determination of the indication for RT and the state of implementation. (2) Multi-institutional retrospective cohort study in fiscal year 2014. Statistical analysis of risk factors for AE. ILD confirmation using CT images by two central radiation diagnosticians. These two studies were included. (1) Questionnaires were returned by 47 institutes. RT was not an option for patients with ILD in 8 of the institutes. Some of the institutes excluded RT from options because of experience of severe adverse events. RT was an option even for patients with ILD depending on conditions of the case in 39 of the institutes. In 37 of the institutes, 3.7% of lung cancer patients (78/2128 patients) in fiscal year 2014 had ILD. (2) Sixty-seven patients were enrolled. AE occurred in 5 cases including 4 photon RT cases. AE occurred in 4 (7.7%) of 52 cases in which photon RT was performed, and there was one RT-induced AE-related death (25.0%). Regarding risk factors for AE, in the t-test, grade of radiation pneumonitis, FEV1, and lung V30 were significant. Age, lung mean dose, lung V20, and DLco were marginally significant. However, they were not significant in multivariate analysis. AE occurred in 1 of 15 cases in which particle RT was performed. In a review of CT images, 59 cases were analyzable. ILD was confirmed in 58 cases (98.3%). Diagnosis of ILD by each institute was almost the same as that in the review by central radiation diagnosticians. Post-irradiation exacerbation of ILD (PIE-ILD) on CT was revealed in 23 (43.4%) of 53 cases. We considered that PIE-ILD does not necessarily progress to AE. We surveyed actual conditions of RT for patients with ILD in Japan. RT was an option even for patients with ILD in many institutes, though cases in which it was actually implemented were limited.
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关键词
radiation therapy,acute exacerbation,interstitial lung disease
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