RISK FACTORS OF PNEUMONITIS FOLLOWING CHEMORADIOTHERAPY FOR LUNG-CANCER

The purpose of this retrospective study was to identify risk factors a ssociated with development of pneumonitis following chemoradiotherapy (CRT). We examined 60 patients (pts) who received CRT from May 1993 to August 1995. Factors evaluated included total radiation dose, held-si ze, irradiated site, type of chemotherapy, pulmonary fibrosis and trea tment schedule (concurrent versus sequential). There were 17 pts (28.3 %) who had greater than or equal to Grade 2 pulmonary toxicity. There was no significant relationship between total radiation dose, field-si ze greater than or equal to 200 cm(2), pulmonary fibrosis or treatment schedule and risk of pneumonitis. In the sequential treatment group ( 22 pts), no relationship was noted between any factor and the risk of pneumonitis, while in the concurrent treatment group (38 pts), the inc idence of pneumonitis was more frequent (53.8%) in patients with field -size greater than or equal to 200 cm(2) than in patients with field-s ize <200cm(2) (P<0.05). In those who received concurrent treatment, in cluding weekly CPT-11, pneumonitis was more frequent (56.3%) than in t hose without CPT-11 (13.6%, P<0.01). When the lower lung field was inc luded in the radiation site, the incidence of pneumonitis was 70% comp ared with 20% for other sites (P<0.01). Multivariate analysis revealed a significant relationship between radiation site and the risk of pne umonitis (P=0.0096). CPT-11 was significant (P=0.038) only in the conc urrent group. Pneumonitis was reversible in all but one pt by steroid therapy. Thus, irradiated site (included lower lung field) and concurr ent CRT used with weekly CPT-11 were treatment factors significantly a ssociated with a higher risk of pneumonitis. following CRT. (C) 1998 E lsevier Science Ltd.