Incidence and correlates of radiation pneumonitis in pediatric patients with partial lung irradiation

Chiaho Hua, Kelly A. Hoth, Shengjie Wu, Larry E. Kun, Monika L. Metzger, Sheri L. Spunt, Xiaoping Xiong, Mathew J. Krasin

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

Purpose: To provide a radiation pneumonitis risk estimate and investigate the correlation of clinical and dosimetric factors in pediatric patients receiving chest irradiation. Methods and Materials: A total of 122 patients diagnosed with sarcoma or Hodgkin lymphoma who received radiotherapy to the chest were evaluated for symptomatic radiation pneumonitis (Common Toxicity Criteria Grade 1 with respiratory symptom or higher grade). Pneumonitis data were collected from either prospective toxicity screenings as part of a clinical trial or through chart review. Dosimetric parameters including V 10-V25, mean lung dose, binned lung dose, and tissue complication probability models were used, as well as clinical features to correlate with the development of pneumonitis. Results: The 1- and 2-year cumulative incidence of symptomatic radiation pneumonitis for all patients was 8.2% and 9.1%, respectively. Nine patients experienced symptomatic Grade 1 toxicity, and 2 experienced Grade 2. From univariate analysis, chemotherapy containing bleomycin (χ2 test, p = 0.027) and V24 (logistic regression, p = 0.019) were the clinical and dosimetric factors that resulted in statistically significant differences in the occurrence of pneumonitis. The probability of pneumonitis increased more dramatically with increasing V24 in patients receiving bleomycin than in those who did not. Adult tissue complication models did not differentiate pediatric patients with radiation pneumonitis from those without. Conclusions: The incidence of symptomatic radiation pneumonitis in pediatric patients is low and its severity mild. Parameters frequently used in adult radiation oncology provide some guidance as to risk, but pediatric patients warrant their own specific models for risk assessment, incorporating dosimetry and clinical factors.

Original languageEnglish (US)
Pages (from-to)143-149
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume78
Issue number1
DOIs
StatePublished - Sep 1 2010

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Keywords

  • Hodgkin lymphoma
  • Pediatric radiotherapy
  • Radiation pneumonitis
  • Sarcoma

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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