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Open Access 01-12-2012 | Research

Organizing pneumonia after stereotactic ablative radiotherapy of the lung

Authors: Taro Murai, Yuta Shibamoto, Takeshi Nishiyama, Fumiya Baba, Akifumi Miyakawa, Shiho Ayakawa, Hiroyuki Ogino, Shinya Otsuka, Hiromitsu Iwata

Published in: Radiation Oncology | Issue 1/2012

Abstract

Background

Organizing pneumonia (OP), so called bronchiolitis obliterans organizing pneumonia after postoperative irradiation for breast cancer has been often reported. There is little information about OP after other radiation modalities. This cohort study investigated the clinical features and risk factors of OP after stereotactic ablative radiotherapy of the lung (SABR).

Methods

Patients undergoing SABR between 2004 and 2010 in two institutions were investigated. Blood test and chest computed tomography were performed at intervals of 1 to 3 months after SABR. The criteria for diagnosing OP were: 1) mixture of patchy and ground-glass opacity, 2) general and/or respiratory symptoms lasting for at least 2 weeks, 3) radiographic lesion in the lung volume receiving < 0.5 Gy, and 4) no evidence of a specific cause.

Results

Among 189 patients (164 with stage I lung cancer and 25 with single lung metastasis) analyzed, nine developed OP. The incidence at 2 years was 5.2% (95% confidence interval; 2.6-9.3%). Dyspnea were observed in all patients. Four had fever. These symptoms and pulmonary infiltration rapidly improved after corticosteroid therapy. Eight patients had presented with symptomatic radiation pneumonitis (RP) around the tumor 2 to 7 months before OP. The prior RP history was strongly associated with OP (hazard ratio 61.7; p = 0.0028) in multivariate analysis.

Conclusions

This is the first report on OP after SABR. The incidence appeared to be relatively high. The symptoms were sometimes severe, but corticosteroid therapy was effective. When patients after SABR present with unusual pneumonia, OP should be considered as a differential diagnosis, especially in patients with prior symptomatic RP.

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American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias: This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med 2002, 165: 277-304.CrossRef

Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M, et al.: Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis. Chest 2011, 139: 893-900. 10.1378/chest.10-0883CrossRefPubMed

Cordier JF: Cryptogenic organising pneumonia. Eur Respir J 2006, 28: 422-446. 10.1183/09031936.06.00013505CrossRefPubMed

Crestani B, Valeyre D, Roden S, et al.: Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. The Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires (GERM"O"P). Am J Respir Crit Care Med 1998, 158: 1929-1935.CrossRefPubMed

Gudavalli R, Diaz-Guzman E, Arrossi AV, et al.: Fleeting alveolar infiltrates and reversed halo sign in patients with breast cancer treated with tangential beam irradiation. Chest 2011, 139: 454-459. 10.1378/chest.10-1573CrossRefPubMed

Kubo A, Osaki K, Kawanaka T, et al.: Risk factors for radiation pneumonitis caused by whole breast irradiation following breast-conserving surgery. J Med Invest 2009, 56: 99-110. 10.2152/jmi.56.99CrossRefPubMed

Takigawa N, Segawa Y, Saeki T, et al.: Bronchiolitis obliterans organizing pneumonia syndrome in breast-conserving therapy for early breast cancer: radiation-induced lung toxicity. Int J Radiat Oncol Biol Phys 2000, 48: 751-755. 10.1016/S0360-3016(00)00654-4CrossRefPubMed

Ogo E, Komaki R, Abe T, et al.: The clinical characteristics and non-steroidal treatment for radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy. Radiother Oncol 2010, 97: 95-100. 10.1016/j.radonc.2010.02.032CrossRefPubMed

Ogo E, Komaki R, Fujimoto K, et al.: A survey of radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy in Japan. Int J Radiat Oncol Biol Phys 2008, 71: 123-131. 10.1016/j.ijrobp.2007.09.003CrossRefPubMed

10.

Katayama N, Sato S, Katsui K, et al.: Analysis of factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy. Int J Radiat Oncol Biol Phys 2009, 73: 1049-1054. 10.1016/j.ijrobp.2008.05.050CrossRefPubMed

11.

Scott WJ, Howington J, Feigenberg S, et al.: Treatment of non-small cell lung cancer stage I and stage II: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007, 132: 234S-242S. 10.1378/chest.07-1378CrossRefPubMed

12.

Takeda A, Kunieda E, Ohashi T, et al.: Severe COPD is correlated with mild radiation pneumonitis following stereotactic body radiotherapy. Chest 2012, 141: 858-866. 10.1378/chest.11-1193CrossRefPubMed

13.

Shibamoto Y, Hashizume C, Baba F, et al.: Stereotactic body radiotherapy using a radiobiology-based regimen for stage I nonsmall cell lung cancer: A multicenter study. Cancer 2012, 118: 2078-2084. 10.1002/cncr.26470CrossRefPubMed

14.

Baba F, Shibamoto Y, Ogino H, et al.: Clinical outcomes of stereotactic body radiotherapy for stage I non-small cell lung cancer using different doses depending on tumor size. Radiat Oncol 2010, 5: 81. 10.1186/1748-717X-5-81PubMedCentralCrossRefPubMed

15.

Nagata Y, Wulf J, Lax I, et al.: Stereotactic radiotherapy of primary lung cancer and other targets: results of consultant meeting of the International Atomic Energy Agency. Int J Radiat Oncol Biol Phys 2011, 79: 660-669. 10.1016/j.ijrobp.2010.10.004CrossRefPubMed

16.

Pan H, Simpson DR, Mell LK, et al.: A survey of stereotactic body radiotherapy use in the United States. Cancer 2011, 117: 4566-4572. 10.1002/cncr.26067PubMedCentralCrossRefPubMed

17.

Baba F, Shibamoto Y, Tomita N, et al.: Stereotactic body radiotherapy for stage I lung cancer and small lung metastasis: evaluation of an immobilization system for suppression of respiratory tumor movement and preliminary results. Radiat Oncol 2009, 4: 15. 10.1186/1748-717X-4-15PubMedCentralCrossRefPubMed

18.

Iwata H, Shibamoto Y, Baba F, et al.: Correlation between the serum KL-6 level and the grade of radiation pneumonitis after stereotactic body radiotherapy for stage I lung cancer or small lung metastasis. Radiother Oncol 2011, 101: 267-270. 10.1016/j.radonc.2011.05.031CrossRefPubMed

19.

Murai T, Shibamoto Y, Baba F, et al.: Progression of non-small-cell lung cancer during the interval before stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 2012, 82: 463-467. 10.1016/j.ijrobp.2010.10.001CrossRefPubMed

20.

Scrucca L, Santucci A, Aversa F: Regression modeling of competing risk using R: an in depth guide for clinicians. Bone Marrow Transplant 2010, 45: 1388-1395. 10.1038/bmt.2009.359CrossRefPubMed

21.

Scrucca L, Santucci A, Aversa F: Competing risk analysis using R: an easy guide for clinicians. Bone Marrow Transplant 2007, 40: 381-387. 10.1038/sj.bmt.1705727CrossRefPubMed

22.

Gray RJ: A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Statist 1988, 16: 1141-1154. 10.1214/aos/1176350951CrossRef

23.

Fine JP, Gray RJ: A proportional hazards model for the subdistribution of a competing risk. J Amer Statist Assoc 1994, 94: 496-509.CrossRef

24.

Putter H, Fiocco M, Geskus RB: Tutorial in biostatistics: competing risks and multi-state models. Stat Med 2007, 26: 2389-2430. 10.1002/sim.2712CrossRefPubMed

25.

De Wreede LC, Fiocco M, Putter H: The mstate package for estimation and prediction in non- and semi-parametric multi-state and competing risks models. Comput Methods Programs Biomed 2010, 99: 261-274. 10.1016/j.cmpb.2010.01.001CrossRefPubMed

26.

R Development Core Team: R: A language and environment for statistical computing. R. Foundation for Statistical Computing, Vienna, Austria; 2011.

27.

Stover DE, Milite F, Zakowski M: A newly recognized syndrome–radiation-related bronchiolitis obliterans and organizing pneumonia. A case report and literature review. Respiration 2001, 68: 540-544. 10.1159/000050566CrossRefPubMed

28.

Cornelissen R, Senan S, Antonisse IE, et al.: Bronchiolitis obliterans organizing pneumonia (BOOP) after thoracic radiotherapy for breast carcinoma. Radiat Oncol 2007, 2: 2. 10.1186/1748-717X-2-2PubMedCentralCrossRefPubMed

29.

Chakraborty M, Abrams SI, Camphausen K, et al.: Irradiation of tumor cells up-regulates Fas and enhances CTL lytic activity and CTL adoptive immunotherapy. J Immunol 2003, 170: 6338-6347.CrossRefPubMed

30.

Chakraborty M, Wansley EK, Carrasquillo JA, et al.: The use of chelated radionuclide (samarium-153-ethylenediaminetetramethylenephosphonate) to modulate phenotype of tumor cells and enhance T cell-mediated killing. Clin Cancer Res 2008, 14: 4241-4249. 10.1158/1078-0432.CCR-08-0335PubMedCentralCrossRefPubMed

31.

Garnett CT, Palena C, Chakraborty M, et al.: Sublethal irradiation of human tumor cells modulates phenotype resulting in enhanced killing by cytotoxic T lymphocytes. Cancer Res 2004, 64: 7985-7994. 10.1158/0008-5472.CAN-04-1525CrossRefPubMed

32.

Martin C, Romero S, Sanchez-Paya J, et al.: Bilateral lymphocytic alveolitis: a common reaction after unilateral thoracic irradiation. Eur Respir J 1999, 13: 727-732. 10.1034/j.1399-3003.1999.13d05.xCrossRefPubMed

33.

Majeski EI, Harley RA, Bellum SC, et al.: Differential role for T cells in the development of fibrotic lesions associated with reovirus 1/L-induced bronchiolitis obliterans organizing pneumonia versus Acute Respiratory Distress Syndrome. Am J Respir Cell Mol Biol 2003, 28: 208-217. 10.1165/rcmb.4891CrossRefPubMed

34.

Lopez AD, Avasarala S, Grewal S, et al.: Differential role of the Fas/Fas ligand apoptotic pathway in inflammation and lung fibrosis associated with reovirus 1/L-induced bronchiolitis obliterans organizing pneumonia and acute respiratory distress syndrome. J Immunol 2009, 183: 8244-8257. 10.4049/jimmunol.0901958PubMedCentralCrossRefPubMed

35.

Blyth BJ, Sykes PJ: Radiation-induced bystander effects: what are they, and how relevant are they to human radiation exposures? Radiat Res 2011, 176: 139-157. 10.1667/RR2548.1CrossRefPubMed

36.

Matsumoto H, Tomita M, Otsuka K, et al.: A new paradigm in radioadaptive response developing from microbeam research. J Radiat Res (Tokyo) 2009,50(Suppl A):A67-A79.CrossRef

37.

Frankel SK, Cosgrove GP, Cha SI, et al.: TNF-alpha sensitizes normal and fibrotic human lung fibroblasts to Fas-induced apoptosis. Am J Respir Cell Mol Biol 2006, 34: 293-304.PubMedCentralCrossRefPubMed

38.

Prise KM, O'Sullivan JM: Radiation-induced bystander signalling in cancer therapy. Nat Rev Cancer 2009, 9: 351-360. 10.1038/nrc2603PubMedCentralCrossRefPubMed

39.

Wittram C, Mark EJ, McLoud TC: CT-histologic correlation of the ATS/ERS 2002 classification of idiopathic interstitial pneumonias. Radiographics 2003, 23: 1057-1071. 10.1148/rg.235035702CrossRefPubMed

40.

Mokhtari M, Bach PB, Tietjen PA, et al.: Bronchiolitis obliterans organizing pneumonia in cancer: a case series. Respir Med 2002, 96: 280-286. 10.1053/rmed.2001.1269CrossRefPubMed

Title: Organizing pneumonia after stereotactic ablative radiotherapy of the lung
Authors: Taro Murai
Yuta Shibamoto
Takeshi Nishiyama
Fumiya Baba
Akifumi Miyakawa
Shiho Ayakawa
Hiroyuki Ogino
Shinya Otsuka
Hiromitsu Iwata
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-7-123

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Organizing pneumonia after stereotactic ablative radiotherapy of the lung

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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