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Title: Updated assessment of the six-minute walk test as predictor of acute radiation-induced pneumonitis

Abstract

Purpose: To assess the utility of the 6-minute walk test (6MWT) as a predictor of symptomatic radiation-induced pneumonitis (RP). Methods: As part of a prospective trial to study radiation-induced lung injury, 53 patients receiving thoracic radiotherapy (RT) underwent a pre-RT 6MWT, pulmonary function tests (PFTs), and had {>=}3-month follow-up for prospective assessment of Grade 2 or worse RP (requiring medications or worse). Dosimetric parameters (e.g., the percentage of lung receiving {>=}30 Gy) were extracted from the lung dose-volume histogram. The correlations between the 6MWT and PFT results were assessed using Pearson's correlation. The receiver operating characteristic technique was used in patient subgroups to evaluate the predictive capacities for RP of the dosimetric parameters, 6MWT results, and PFT results, or the combination (using discriminant analysis) of all three metrics. ROCKIT software was used to compare the receiver operating characteristic areas between each predictive model. The association of the decline in 6MWT with the development of RP was evaluated using Fisher's exact test. Results: The pre-RT PFT and 6MWT results correlated weakly (r = 0.44-0.57, p {<=} 0.001), suggesting that they measure somewhat different physiologic functions. Of the 53 patients, 9 (17%) developed RP. The dose-volume histogram-based dosimetric parameters were the bestmore » single-metric model for predicting RP (e.g., percentage of lung receiving {>=}30 Gy, receiver operating characteristic area 0.73, p = 0.03). Including the PFT or 6MWT results with the percentage of lung receiving {>=}30 Gy did not improve the predictions. The predictive abilities of dosimetric-based models improved when the analysis was restricted to those patients whose tumors were not causing regional lung dysfunction. No correlation was found between the decline in the 6MWT result and the RP rate (p = 0.6). Conclusion: Although the PFTs and 6MWT are related to each other, the correlation coefficients were weak, suggesting that they could be measuring different physiologic functions. In the present data set, the addition of the PFTs or 6MWT did not increase the ability of the dosimetric parameters to predict for acute symptomatic RP. Additional work is needed to better understand the interaction among the PFT results, exercise tolerance (6MWT), and the risk of RT-induced lung dysfunction.« less

Authors:
 [1];  [2];  [1];  [1];  [1];  [3];  [4];  [5];  [6]
  1. Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)
  2. (China)
  3. Department of Biostatistics, Duke University Medical Center, Durham, NC (United States)
  4. Department of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC (United States)
  5. Department of Radiology, Duke University Medical Center, Durham, NC (United States)
  6. Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States). E-mail: lawrence.marks@duke.edu
Publication Date:
OSTI Identifier:
20944726
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2006.10.001; PII: S0360-3016(06)03241-X; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; COMPUTER CODES; INJURIES; LUNGS; PATIENTS; PNEUMONITIS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Mao Jingfang, Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai, Zhang Junan, Zhou Sumin, Das, Shiva, Hollis, Donna R., Folz, Rodney J., Wong, Terence Z., and Marks, Lawrence B.. Updated assessment of the six-minute walk test as predictor of acute radiation-induced pneumonitis. United States: N. p., 2007. Web.
Mao Jingfang, Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai, Zhang Junan, Zhou Sumin, Das, Shiva, Hollis, Donna R., Folz, Rodney J., Wong, Terence Z., & Marks, Lawrence B.. Updated assessment of the six-minute walk test as predictor of acute radiation-induced pneumonitis. United States.
Mao Jingfang, Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai, Zhang Junan, Zhou Sumin, Das, Shiva, Hollis, Donna R., Folz, Rodney J., Wong, Terence Z., and Marks, Lawrence B.. Thu . "Updated assessment of the six-minute walk test as predictor of acute radiation-induced pneumonitis". United States. doi:.
@article{osti_20944726,
title = {Updated assessment of the six-minute walk test as predictor of acute radiation-induced pneumonitis},
author = {Mao Jingfang and Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai and Zhang Junan and Zhou Sumin and Das, Shiva and Hollis, Donna R. and Folz, Rodney J. and Wong, Terence Z. and Marks, Lawrence B.},
abstractNote = {Purpose: To assess the utility of the 6-minute walk test (6MWT) as a predictor of symptomatic radiation-induced pneumonitis (RP). Methods: As part of a prospective trial to study radiation-induced lung injury, 53 patients receiving thoracic radiotherapy (RT) underwent a pre-RT 6MWT, pulmonary function tests (PFTs), and had {>=}3-month follow-up for prospective assessment of Grade 2 or worse RP (requiring medications or worse). Dosimetric parameters (e.g., the percentage of lung receiving {>=}30 Gy) were extracted from the lung dose-volume histogram. The correlations between the 6MWT and PFT results were assessed using Pearson's correlation. The receiver operating characteristic technique was used in patient subgroups to evaluate the predictive capacities for RP of the dosimetric parameters, 6MWT results, and PFT results, or the combination (using discriminant analysis) of all three metrics. ROCKIT software was used to compare the receiver operating characteristic areas between each predictive model. The association of the decline in 6MWT with the development of RP was evaluated using Fisher's exact test. Results: The pre-RT PFT and 6MWT results correlated weakly (r = 0.44-0.57, p {<=} 0.001), suggesting that they measure somewhat different physiologic functions. Of the 53 patients, 9 (17%) developed RP. The dose-volume histogram-based dosimetric parameters were the best single-metric model for predicting RP (e.g., percentage of lung receiving {>=}30 Gy, receiver operating characteristic area 0.73, p = 0.03). Including the PFT or 6MWT results with the percentage of lung receiving {>=}30 Gy did not improve the predictions. The predictive abilities of dosimetric-based models improved when the analysis was restricted to those patients whose tumors were not causing regional lung dysfunction. No correlation was found between the decline in the 6MWT result and the RP rate (p = 0.6). Conclusion: Although the PFTs and 6MWT are related to each other, the correlation coefficients were weak, suggesting that they could be measuring different physiologic functions. In the present data set, the addition of the PFTs or 6MWT did not increase the ability of the dosimetric parameters to predict for acute symptomatic RP. Additional work is needed to better understand the interaction among the PFT results, exercise tolerance (6MWT), and the risk of RT-induced lung dysfunction.},
doi = {},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 67,
place = {United States},
year = {Thu Mar 01 00:00:00 EST 2007},
month = {Thu Mar 01 00:00:00 EST 2007}
}
  • Purpose: To determine the relationship between various parameters derived from lung dose-volume histogram analysis and the risk of symptomatic radiation pneumonitis (RP) in patients undergoing radical radiotherapy for primary lung cancer. Methods and Materials: The records of 156 patients with lung cancer who had been treated with radical radiotherapy ({>=}45 Gy) and for whom dose-volume histogram data were available were reviewed. The incidence of symptomatic RP was correlated with a variety of parameters derived from the dose-volume histogram data, including the volume of lung receiving 10 Gy (V{sub 10}) through 50 Gy (V{sub 50}) and the mean lung dose (MLD).more » Results: The rate of RP at 6 months was 15% (95% confidence interval 9-22%). On univariate analysis, only V{sub 30} (p = 0.036) and MLD (p = 0.043) were statistically significantly related to RP. V{sub 30} correlated highly positively with MLD (r = 0.96, p < 0.001). Conclusion: V{sub 30} and MLD can be used to predict the risk of RP in lung cancer patients undergoing radical radiotherapy.« less
  • Purpose: To quantify the relationship between bone marrow (BM) response to radiation and radiation dose by using {sup 18}F-labeled fluorodeoxyglucose positron emission tomography [{sup 18}F]FDG-PET standard uptake values (SUV) and to correlate these findings with hematological toxicity (HT) in cervical cancer (CC) patients treated with chemoradiation therapy (CRT). Methods and Materials: Seventeen women with a diagnosis of CC were treated with standard doses of CRT. All patients underwent pre- and post-therapy [{sup 18}F]FDG-PET/computed tomography (CT). Hemograms were obtained before and during treatment and 3 months after treatment and at last follow-up. Pelvic bone was autosegmented as total bone marrow (BM{sub TOT}).more » Active bone marrow (BM{sub ACT}) was contoured based on SUV greater than the mean SUV of BM{sub TOT}. The volumes (V) of each region receiving 10, 20, 30, and 40 Gy (V{sub 10}, V{sub 20}, V{sub 30}, and V{sub 40}, respectively) were calculated. Metabolic volume histograms and voxel SUV map response graphs were created. Relative changes in SUV before and after therapy were calculated by separating SUV voxels into radiation therapy dose ranges of 5 Gy. The relationships among SUV decrease, radiation dose, and HT were investigated using multiple regression models. Results: Mean relative pre-post-therapy SUV reductions in BM{sub TOT} and BM{sub ACT} were 27% and 38%, respectively. BM{sub ACT} volume was significantly reduced after treatment (from 651.5 to 231.6 cm{sup 3}, respectively; P<.0001). BM{sub ACT} V{sub 30} was significantly correlated with a reduction in BM{sub ACT} SUV (R{sup 2}, 0.14; P<.001). The reduction in BM{sub ACT} SUV significantly correlated with reduction in white blood cells (WBCs) at 3 months post-treatment (R{sup 2}, 0.27; P=.04) and at last follow-up (R{sup 2}, 0.25; P=.04). Different dosimetric parameters of BM{sub TOT} and BM{sub ACT} correlated with long-term hematological outcome. Conclusions: The volumes of BM{sub TOT} and BM{sub ACT} that are exposed to even relatively low doses of radiation are associated with a decrease in WBC counts following CRT. The loss in proliferative BM SUV uptake translates into low WBC nadirs after treatment. These results suggest the potential of intensity modulated radiation therapy to spare BM{sub TOT} to reduce long-term hematological toxicity.« less
  • Lung compliance is decreased by radiations. The change is less severe if the animal is irradiated at high O/sub 2/ tensions. It was also found that the adrenals were heavier in the high O/sub 2/ group than in the low O/sub 2/ group. It is suggested that the severe skin and marrow reaction produced in the high O/sub 2/ group results in adrenal hyperplasia with the increased production of endogenous cortisone and the subsequent suppression of compliance changes. (auth)
  • The effect of steroids, heparin, and antibiotics upon radiation lung damage was studied in rats. Total chest compliance, the relation of pressure to volume, was selected as the measure of damage. Irradiation decreased compliance. This change was unaffected by heparin but was questionably prevented by antibiotics. Cortisone definitely reduced the severity of acute radiation- induced lung damage. (auth)