Risk Factors of Radiation Pneumonitis in Patients with NSCLC Treated with Concomitant Chemoradiotherapy-Are We Underestimating Diabetes?-Turkish Oncolog Group/Lung Cancer Study Group

To evaluate the clinical and dosimetric parameters that increase the risk of radiation pneumonitis (RP) in locally advanced non-small cell lung cancer patients treated with concomitant chemoradiotherapy of nationwide multicentric data analysis. All data of 268 patients who underwent definitive chemoradiotherapy were retrospectively collected from 8 institutes participating in this study. Patient, tumor, and treatment-related factors and dosimetric parameters were analyzed for grade ≥2 RP. The toxicity scoring system of The Radiation Therapy Oncology Group used for grading the severity of pneumonitis. A relationship with the risk of RP with potential predictive factors were evaluated by univariate and multivariate analyses. A recursive partition analysis (RPA) was applied to stratify patients according to the risk of developing RP. There were 90 (33.6%) patients who had grade ≥2 RP. The median time to pneumonitis after treatment was 4 months (range:1-6 months). In univariate analysis, diabetes mellitus (DM), use of cisplatin/etoposide, total and daily radiotherapy fraction dose, the planning target volume size, mean lung dose, V5, V10, and radiotherapy technique were associated with the development of pneumonitis. In multivariate analysis, only DM (p=0.008) was found to be independent risk factors for RP. According to RPA, the risk of developing RP was highest in patients with DM. In our study, besides the known dosimetric factors, DM was found to be the most important risk factor causing RP development in multivariate analysis and RPA.The risk is tripled compared to patients without DM.