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Patient-reported lung symptoms as an early signal of impending radiation pneumonitis in patients with non-small cell lung cancer treated with chemoradiation: an observational study.

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Title:	Patient-reported lung symptoms as an early signal of impending radiation pneumonitis in patients with non-small cell lung cancer treated with chemoradiation: an observational study.
Authors:	Yue, Jinbo, Shi, Qiuling, Xu, Ting, Jeter, Melenda, Chen, Ting-Yu, Komaki, Ritsuko, Gomez, Daniel R., Pan, Tinsu, Cleeland, Charles S., Liao, Zhongxing, Wang, Xin Shelley
Source:	Quality of Life Research. Jun2018, Vol. 27 Issue 6, p1563-1570. 8p. 2 Charts, 1 Graph.
Subjects:	Radiation pneumonitis, Cancer treatment, Non-small-cell lung carcinoma, Radiotherapy complications, Positron emission tomography, Computed tomography, Lung cancer treatment, Confidence intervals, Deoxy sugars, Health outcome assessment, Radiopharmaceuticals, Research funding, Logistic regression analysis, Secondary analysis, Data analysis software, Descriptive statistics, Chemoradiotherapy, Symptoms, Diagnosis
Abstract:	Purpose: Clinician ratings of concurrent chemoradiation (CRT)-induced radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) are based on both imaging and patient-reported lung symptoms. We compared the value of patient-reported outcomes versus normal-lung uptake of 18F-fluoro-2-deoxyglucose in positron emission computed tomography (FDG PET/CT) during the last week of treatment, for indicating the development of grade ≥ 2 RP within 4 months of CRT completion.Methods: 132 patients with NSCLC-reported RP-related symptoms (coughing, shortness of breath) repeatedly using the validated MD Anderson Symptom Inventory lung cancer module. Of these patients, 68 had FDG PET/CT scans that were analyzed for normal-lung mean standardized FDG uptake values (SUVmean) before, during, and up to 4 months after CRT. Clinicians rated RP using CTCAE version 3. Logistic regression models examined potential predictors for developing CTCAE RP ≥ 2.Results: For the entire sample, patient-rated RP-related symptoms during the last week of CRT correlated with clinically meaningful CTCAE RP ≥ 2 post-CRT (OR 2.74, 95% CI 1.25-5.99, P = 0.012), controlled for sex, age, mean lung radiation dose, comorbidity, and baseline symptoms. Moderate/severe patient-rated RP-related symptom score (≥ 4 on a 0-10 scale, P = 0.001) and normal-lung FDG uptake (SUVmean > 0.78, P = 0.002) in last week of CRT were equally strong predictors of post-CRT CTCAE RP ≥ 2 (C-index = 0.78, 0.77).Conclusions: During the last week of CRT, routine assessment of moderate-to-severe RP-related symptoms provides a simple way to identify patients with NSCLC who may be at risk for developing significant post-CRT RP, especially when PET/CT images of normal-lung FDG uptake are not available. [ABSTRACT FROM AUTHOR]
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Database:	Psychology and Behavioral Sciences Collection
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