Transcript Decreased Risk of Radiation Pneumonitis With

Decreased Risk of Radiation Pneumonitis With
Coincident Concurrent Use Of AngiotensinConverting Enzyme Inhibitors In Patients
Receiving Lung Stereotactic Body Radiation
Therapy (SBRT)
Fiori Alite, M. Surucu, I. Mescioglu, M.
Harkenrider
Loyola University Medical Center, Maywood, IL
Introduction
• Angiotensin Converting Enzymes have demonstrated efficacy in preclinical
models of ameliorating lung radiation toxicity
• 4 Retrospective reviews have demonstrated conflicting results in terms of
documenting improvement of symptomatic radiation pneumonitis
• RTOG 0123 was initiated to test efficacy of the ACEi captopril to decrease rates
of symptomatic pneumonitis in patients treated with radiation for locally
advanced non-small cell and small cell lung carcinoma
• To our knowledge, effect of concurrent ACEi use in patients treated with lung
SBRT has not been tested
• The objective of this study was to evaluate retrospectively the role of
concurrent incidental use of ACE inhibitors in ameliorating development of
symptomatic acute lung toxicity in the setting of thoracic SBRT.
Materials and Methods
• A retrospective review of patients treated with thoracic SBRT analyzing rates of incidental
concurrent use of ACEi and development of symptomatic pneumonitis was performed.
• We analyzed 193 patients treated with Linac-based SBRT with for primary, recurrent and
metastatic lung tumors. Patients were treated with doses of 40-60Gy in 3-5 fractions from 2006
to 2013.
• These plans were evaluated to meet RTOG 0236 criteria for dose coverage and lung tolerance.
• We recorded symptomatic pneumonitis up to 6 months post treatment based on Common
Terminology Criteria for Adverse Events Version 4.0.
• Pre and post treatment medication profiles were reviewed to document use of ACE inhibitors,
angiotensin receptor blockers, bronchodilators, ASA, PDE5 inhibitors, nitrates and endothelin
receptor antagonists. A decision tree analysis was performed to investigate the risk factors for
development of symptomatic pneumonitis.
• Patient age, sex, KPS, clinical stage, tumor location, prescription dose, and concurrent use of 7
different bronchoactive medications were used to train this decision tree.
Results
• The majority (85%) of patients were treated with 50Gy in 5 fractions, and
8% of patients with 60Gy in 5 fraction.
• Twenty three patients experienced Grade 2 or higher pneumonitis, an
absolute rate of 11.9%.
• Forty-eight patients (24.9%) were found to be on ACEi during delivery of
SBRT.
• Only one patient on a concurrent ACEi experienced symptomatic
pneumonitis.
• The rate of Grade 2 or higher pneumonitis was significantly lower in
patients prescribed an ACEi vs. patients not on an ACEi (2% vs. 15%, χ2
test p = 0.01).
• Additionally, in a decision tree analysis accounting for the clinical/patient
characteristics and medication profiles we can predict with 92% accuracy
that patients on an ACEi will not experience symptomatic pneumonitis.
Patient Characteristics
Decision Tree Analysis
No 47/1
Conclusions
• ACEi appear to have efficacy in diminishing rates of symptomatic
pneumonitis in the setting of lung stereotactic body radiation therapy
which was validated in a decision tree statistical analysis.
• With the advent of increased lung cancer screening as well as
expanding clinical practice of treating lung oligometastases, identifying
toxicity modifiers in this population with often compromised lung
function is important.
• This is of particular concern in patients that are receiving several
courses of radiation to the chest, or patients treated to multiple sites
and overall greater lung volume.
• Prospective analysis is needed to confirm these findings.
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