Longitudinal evaluation of lung function in patients with advanced Non-small cell lung cancer treated with concurrent chemo-radiotherapy

Publication date: Available online 12 April 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Luis Torre-Bouscoulet, Marisol Arroyo-Hernández, David Martínez-Briseño, Wendy R. Muñoz-Montaño, Laura Gochicoa-Rangel, Ludwing Bacon-Fonseca, Rogelio Pérez-Padilla, Edgar Vergara, Cecilia García-Sancho, F. Lozano-Ruiz, Rosario Fernández-Plata, Abigail Guzmán-Barragán, Oscar Arrieta
BackgroundIn lung cancer patients, radiotherapy modifies lung architecture resulting in functional deterioration, which worsens symptoms and reduces quality of life.MethodsA multicenter prospective longitudinal study was conducted was conducted in a cohort of patients with locally advanced and oligometastatic Non-small cell lung cancer (NSCLC) treated with concurrent chemo-radiotherapy (CCRT). A wide array of pulmonary function tests (forced spirometry, body plethysmography, impulse oscillometry (IOS), carbon monoxide diffusing capacity (DLCO), fraction of exhaled nitric oxide (FeNO), arterial blood gases and a 6-min walk test) were used to evaluate lung function at baseline, after radiotherapy (RT), and 6, 12, 24 and 48 weeks post-CCRT. Relative changes in test results (%) were estimated at the aforementioned intervals and compared with baseline results.ResultsThirty-seven patients completed the follow-up and were included in the analysis. After CCRT, patients showed a maximum decline in lung volumes as follows: a) 31% in FEV1 after 24 weeks (p=0.008); b) 9.6% in FVC after 48 weeks (p=0.04); c) 15.1% in TLC after (p=0.0015). Similarly, 12 weeks post-CCRT patients showed a 21.8% decrease in DLCO, (p=0.002). Increases were found in total airway resistance (R5), frequency-dependence of resistance (Delta R5-R20, p=0.012), and reactance (X5p=0.0003 and Axp=0.001), which together indicate small-airway dysfunction.ConclusionsThe longitudinal evaluation of lung function through PFTs detects CCRT-induced damage before the appearance of clinical symptoms associated with CCRT lung toxicity. Protocol registration in www.clinicaltrials.gov: NCTXXXXXXXXX.

Teaser

This study prospectively evaluated how concurrent radiotherapy (CCRT), a common therapeutic course for lung cancer, affects pulmonary function tests (PFT) initially, throughout and after treatment. The longitudinal evaluation with PFT efficiently detected early changes in lung function after CCRT-induced damage; these changes are independent of the presence of symptoms. We document the longitudinal evaluation of lung function through PFTs and detected CCRT-induced damage before the appearance of clinical symptoms associated with CCRT lung toxicity.


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