Does Bleomycin lung toxicity increase the risk of radiation pneumonitis in Hodgkin Lymphoma?

Publication date: Available online 22 August 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Z. A. Abou Yehia, N.G. Mikhaeel, G. Smith, C.C. Pinnix, S.A. Milgrom, C. Tang, W. Jiang, M. Fanale, Y. Oki, J. Shank, P. Horace, J. Reddy, M. Akhtari, J.R. Gunther, O. Mawlawi, P.K. Allen, B.S. Dabaja
PurposeBleomycin pulmonary toxicity (BPT) is a well-known complication of treatment in HL patients. We undertook this study to investigate the risk of radiation pneumonitis (RP) in the setting of BPT and to determine the need for delay or omission of radiation in these patients.MethodsWe identified 123 HL patients treated with ABVD followed by radiation therapy (RT) to the chest between January 2009 and December 2014. Medical records were reviewed for clinical, pathologic, and treatment information as well as toxicities. Our primary outcome was RP of any grade. Univariate and multivariate analysis were used to assess the association of BPT, baseline patient characteristics and treatment variables to the incidence of RP.Results123 patients were included of which 99 patients (80%) received consolidation IMRT after ABVD treatment. We identified 31 patients (25.2%) with BPT following frontline ABVD. Seventeen patients (13.8%) developed RP at a median of 8 weeks after completion of RT (range: 1-39 weeks). BPT did not correlate with the risk of developing RP (p= 0.36). We evaluated RP outcomes with respect to B-RT interval (≤6 weeks vs. > 6 weeks) and we found that this interval did not predict for RP risk (P=0.60). Dosimetric parameters such as V5 and MLD were analyzed; V5 > 55% and MLD > 13.5 Gy were found to increase the risk of RP by 1.14 fold (p= 0.002) and 4.24 fold (P=0.007), respectively.ConclusionOur study suggested that BPT doesn't increase the risk of developing RP. Furthermore, time to RT initiation does not need to be delayed following chemotherapy except to allow for the completion of steroids or clinical recovery from BPT.

Teaser

Bleomycin pulmonary toxicity (BPT) is a well-known complication of treatment in HL patients. We reviewed HL patients treated with ABVD and Mediastinal RT and we compared the risk of RP in patients who developed BPT versus those who didn't. Patients with BPT who received standard RT had no excess risk of subsequent RP; moreover, time to RT initiation did not influence the risk of developing RP.


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