Incidence of radiation pneumonitis after hepatic intra-arterial radiotherapy with yttrium-90 microspheres assuming uniform lung distribution

Riad Salem*, Pankit Parikh, Bassel Atassi, Robert J. Lewandowski, Robert K. Ryu, Kent T. Sato, Vanessa L. Gates, Saad Ibrahim, Mary F. Mulcahy, Laura Kulik, David M. Liu, Ahsun Riaz, Reed A. Omary, Andrew S. Kennedy

*Corresponding author for this work

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Objective: To assess the incidence of clinical and imaging radiation pneumonitis (RP) in a cohort of patients treated with >30 Gy cumulative lung dose (CLD) using Y90 microspheres. Materials and Methods: Four hundred three patients were treated with Y90 microspheres during a 4-year period. Of these, 58 patients received >30 Gy CLD. Patients were followed for toxicities suggestive of imaging or clinical RP. Toxicities were graded using the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema. Patients were also followed for survival from time of first treatment. Results: There were 44 men and 14 women. Forty-three patients had hepatocellular carcinoma (HCC), whereas 15 had liver metastases. Mean and median follow-up were 7.3 and 6.0 months, respectively. Mean lung shunt fraction was slightly greater in the patients with HCC versus metastases (20% vs. 16.7%, P = 0.2308). The lifetime CLD for metastases and HCC groups were not statistically different (54.04 Gy vs. 48.44 Gy, P = 0.4303). Forty-three of 53 patients demonstrated no lung imaging findings suggestive of pneumonitis. Imaging findings in 10 patients included pleural effusions, atelectasis, and ground glass attenuation. There were no cases of clinical or imaging RP. Survival varied depending on stage as well as single and CLD. None of the patient deaths were attributed to respiratory compromise. Conclusion: RP was not predicted using the currently used Y90 dosimetry models that assume uniform distribution in the lungs. Further investigation and dose escalation studies are required to more precisely define the radiation tolerance of lung parenchyma using this mode of therapy.

Original languageEnglish (US)
Pages (from-to)431-438
Number of pages8
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume31
Issue number5
DOIs
StatePublished - Oct 1 2008

Fingerprint

Radiation Pneumonitis
Yttrium
Microspheres
Radiotherapy
Lung
Liver
Incidence
Hepatocellular Carcinoma
Neoplasm Metastasis
Radiation Oncology
Pulmonary Atelectasis
Survival
Radiation Tolerance
Pleural Effusion
Glass
Pneumonia
Radiation

Keywords

  • Brachytherapy
  • Intra-arterial brachytherapy
  • Radioembolization
  • SIR-spheres
  • TheraSphere
  • Yttrium-90 microspheres

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{2a1cc645987b41d88c3bab8b8e65fcbb,
title = "Incidence of radiation pneumonitis after hepatic intra-arterial radiotherapy with yttrium-90 microspheres assuming uniform lung distribution",
abstract = "Objective: To assess the incidence of clinical and imaging radiation pneumonitis (RP) in a cohort of patients treated with >30 Gy cumulative lung dose (CLD) using Y90 microspheres. Materials and Methods: Four hundred three patients were treated with Y90 microspheres during a 4-year period. Of these, 58 patients received >30 Gy CLD. Patients were followed for toxicities suggestive of imaging or clinical RP. Toxicities were graded using the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema. Patients were also followed for survival from time of first treatment. Results: There were 44 men and 14 women. Forty-three patients had hepatocellular carcinoma (HCC), whereas 15 had liver metastases. Mean and median follow-up were 7.3 and 6.0 months, respectively. Mean lung shunt fraction was slightly greater in the patients with HCC versus metastases (20{\%} vs. 16.7{\%}, P = 0.2308). The lifetime CLD for metastases and HCC groups were not statistically different (54.04 Gy vs. 48.44 Gy, P = 0.4303). Forty-three of 53 patients demonstrated no lung imaging findings suggestive of pneumonitis. Imaging findings in 10 patients included pleural effusions, atelectasis, and ground glass attenuation. There were no cases of clinical or imaging RP. Survival varied depending on stage as well as single and CLD. None of the patient deaths were attributed to respiratory compromise. Conclusion: RP was not predicted using the currently used Y90 dosimetry models that assume uniform distribution in the lungs. Further investigation and dose escalation studies are required to more precisely define the radiation tolerance of lung parenchyma using this mode of therapy.",
keywords = "Brachytherapy, Intra-arterial brachytherapy, Radioembolization, SIR-spheres, TheraSphere, Yttrium-90 microspheres",
author = "Riad Salem and Pankit Parikh and Bassel Atassi and Lewandowski, {Robert J.} and Ryu, {Robert K.} and Sato, {Kent T.} and Gates, {Vanessa L.} and Saad Ibrahim and Mulcahy, {Mary F.} and Laura Kulik and Liu, {David M.} and Ahsun Riaz and Omary, {Reed A.} and Kennedy, {Andrew S.}",
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Incidence of radiation pneumonitis after hepatic intra-arterial radiotherapy with yttrium-90 microspheres assuming uniform lung distribution. / Salem, Riad; Parikh, Pankit; Atassi, Bassel; Lewandowski, Robert J.; Ryu, Robert K.; Sato, Kent T.; Gates, Vanessa L.; Ibrahim, Saad; Mulcahy, Mary F.; Kulik, Laura; Liu, David M.; Riaz, Ahsun; Omary, Reed A.; Kennedy, Andrew S.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 31, No. 5, 01.10.2008, p. 431-438.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence of radiation pneumonitis after hepatic intra-arterial radiotherapy with yttrium-90 microspheres assuming uniform lung distribution

AU - Salem, Riad

AU - Parikh, Pankit

AU - Atassi, Bassel

AU - Lewandowski, Robert J.

AU - Ryu, Robert K.

AU - Sato, Kent T.

AU - Gates, Vanessa L.

AU - Ibrahim, Saad

AU - Mulcahy, Mary F.

AU - Kulik, Laura

AU - Liu, David M.

AU - Riaz, Ahsun

AU - Omary, Reed A.

AU - Kennedy, Andrew S.

PY - 2008/10/1

Y1 - 2008/10/1

N2 - Objective: To assess the incidence of clinical and imaging radiation pneumonitis (RP) in a cohort of patients treated with >30 Gy cumulative lung dose (CLD) using Y90 microspheres. Materials and Methods: Four hundred three patients were treated with Y90 microspheres during a 4-year period. Of these, 58 patients received >30 Gy CLD. Patients were followed for toxicities suggestive of imaging or clinical RP. Toxicities were graded using the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema. Patients were also followed for survival from time of first treatment. Results: There were 44 men and 14 women. Forty-three patients had hepatocellular carcinoma (HCC), whereas 15 had liver metastases. Mean and median follow-up were 7.3 and 6.0 months, respectively. Mean lung shunt fraction was slightly greater in the patients with HCC versus metastases (20% vs. 16.7%, P = 0.2308). The lifetime CLD for metastases and HCC groups were not statistically different (54.04 Gy vs. 48.44 Gy, P = 0.4303). Forty-three of 53 patients demonstrated no lung imaging findings suggestive of pneumonitis. Imaging findings in 10 patients included pleural effusions, atelectasis, and ground glass attenuation. There were no cases of clinical or imaging RP. Survival varied depending on stage as well as single and CLD. None of the patient deaths were attributed to respiratory compromise. Conclusion: RP was not predicted using the currently used Y90 dosimetry models that assume uniform distribution in the lungs. Further investigation and dose escalation studies are required to more precisely define the radiation tolerance of lung parenchyma using this mode of therapy.

AB - Objective: To assess the incidence of clinical and imaging radiation pneumonitis (RP) in a cohort of patients treated with >30 Gy cumulative lung dose (CLD) using Y90 microspheres. Materials and Methods: Four hundred three patients were treated with Y90 microspheres during a 4-year period. Of these, 58 patients received >30 Gy CLD. Patients were followed for toxicities suggestive of imaging or clinical RP. Toxicities were graded using the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema. Patients were also followed for survival from time of first treatment. Results: There were 44 men and 14 women. Forty-three patients had hepatocellular carcinoma (HCC), whereas 15 had liver metastases. Mean and median follow-up were 7.3 and 6.0 months, respectively. Mean lung shunt fraction was slightly greater in the patients with HCC versus metastases (20% vs. 16.7%, P = 0.2308). The lifetime CLD for metastases and HCC groups were not statistically different (54.04 Gy vs. 48.44 Gy, P = 0.4303). Forty-three of 53 patients demonstrated no lung imaging findings suggestive of pneumonitis. Imaging findings in 10 patients included pleural effusions, atelectasis, and ground glass attenuation. There were no cases of clinical or imaging RP. Survival varied depending on stage as well as single and CLD. None of the patient deaths were attributed to respiratory compromise. Conclusion: RP was not predicted using the currently used Y90 dosimetry models that assume uniform distribution in the lungs. Further investigation and dose escalation studies are required to more precisely define the radiation tolerance of lung parenchyma using this mode of therapy.

KW - Brachytherapy

KW - Intra-arterial brachytherapy

KW - Radioembolization

KW - SIR-spheres

KW - TheraSphere

KW - Yttrium-90 microspheres

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JO - American Journal of Clinical Oncology

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