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Radiation-Induced Lung and Heart Toxicity

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Advances in Radiation Oncology in Lung Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

For many patients with lung cancer, thoracic radiation therapy (TRT) is an integral part of their treatment. The effect of TRT on normal structures is an important consideration when optimizing treatment plans for patients. This chapter will review radiation therapy (RT)-induced lung and heart injury including both the clinical and biological mechanisms for these toxicities. It will also analyze the variety of predictors of RT-induced lung and heart damage as well as methods to prevent and treat these toxicities.

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References

  • Abid SH, Malhotra V, Perry MC (2001) Radiation-induced and chemotherapy-induced pulmonary injury. Curr Opin Oncol 13:242–248

    Article  PubMed  CAS  Google Scholar 

  • Abratt RP, Willcox PA, Smith JA (1990) Lung cancer in patients with borderline lung functions–zonal lung perfusion scans at presentation and lung function after high dose irradiation. Radiother Oncol 19:317–322

    Article  PubMed  CAS  Google Scholar 

  • Adams MJ, Lipshultz SE, Schwartz C et al (2003a) Radiation-associated cardiovascular disease: manifestations and management. Semin Radiat Oncol 13:346–356

    Article  PubMed  Google Scholar 

  • Adams MJ, Hardenbergh PH, Constine LS et al (2003b) Radiation-associated cardiovascular disease. Crit Rev Oncol Hematol 45:55–75

    Article  PubMed  Google Scholar 

  • Aleman BM, van den Belt-Dusebout AW, De Bruin ML et al (2007) Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood 109:1878–1886

    Article  PubMed  CAS  Google Scholar 

  • Amromin GD, Gildenhorn HL, Solomon RD et al (1964) The synergism of X-irradiation and cholesterol-fat feeding on the development of coronary artery lesions. J Atheroscler Res 24:325–334

    Article  Google Scholar 

  • Anscher MS, Murase T, Prescott DM et al (1994) Changes in plasma TGF beta levels during pulmonary radiotherapy as a predictor of the risk of developing radiation pneumonitis. Int J Radiat Oncol Biol Phys 30:671–676

    Article  PubMed  CAS  Google Scholar 

  • Anscher MS, Marks LB, Shafman TD et al (2001) Using plasma transforming growth factor beta-1 during radiotherapy to select patients for dose escalation. J Clin Oncol 19:3758–3765

    PubMed  CAS  Google Scholar 

  • Antonadou D, Coliarakis N, Synodinou M et al (2001) Randomized phase III trial of radiation treatment ± amifostine in patients with advanced-stage lung cancer. Int J Radiat Oncol Biol Phys 51:915–922

    Article  PubMed  CAS  Google Scholar 

  • Applefeld MM, Wiernik PH (1983) Cardiac disease after radiation therapy for Hodgkin’s disease: analysis of 48 patients. Am J Cardiol 51:1679–1681

    Article  PubMed  CAS  Google Scholar 

  • Artom C, Lofland HB Jr, Clarkson TB (1965) Ionizing radiation, atherosclerosis, and lipid metabolism in pigeons. Radiat Res 26:165–177

    Article  PubMed  CAS  Google Scholar 

  • Barriger RB, Fakiris AJ, Hanna N et al (2010) Dose–Volume Analysis of Radiation Pneumonitis in Non–Small-Cell Lung Cancer Patients Treated With Concurrent Cisplatinum and Etoposide With or Without Consolidation Docetaxel. International Journal of Radiation OncologyBiologyPhysics 78:1381–1386

    Article  CAS  Google Scholar 

  • Belderbos JSA, De Jaeger K, Heemsbergen WD et al (2003) First results of a phase I/II dose escalation trial in non-small cell lung cancer using three-dimensional conformal radiotherapy. Radiother Oncol 66:119–126

    Article  PubMed  Google Scholar 

  • Bell J, McGivern D, Bullimore J et al (1988) Diagnostic imaging of post-irradiation changes in the chest. Clin Radiol 39:109–119

    PubMed  CAS  Google Scholar 

  • Boivin JF, Hutchison GB (1982) Coronary heart disease mortality after irradiation for Hodgkin’s disease. Cancer 49:2470–2475

    Article  PubMed  CAS  Google Scholar 

  • Boivin JF, Hutchison GB, Lubin JH et al (1992) Coronary artery disease mortality in patients treated for Hodgkin’s disease. Cancer 69:1241–1247

    Article  PubMed  CAS  Google Scholar 

  • Bonnet RB, Bush D, Cheek GA et al (2001) Effects of proton and combined proton/photon beam radiation on pulmonary function in patients with resectable but medically inoperable non-small cell lung cancer. Chest 120:1803–1810

    Article  PubMed  CAS  Google Scholar 

  • Brach MA, Hass R, Sherman ML et al (1991) Ionizing radiation induces expression and binding activity of the nuclear factor kappa B. J Clin Invest 88:691–695

    Article  PubMed  CAS  Google Scholar 

  • Brady LW, Germon PA, Cander L (1965) The Effects of Radiation Therapy on Pulmonary Function in Carcinoma of the Lung. Radiology 85:130–134

    PubMed  CAS  Google Scholar 

  • Brierley JD, Rathmell AJ, Gospodarowicz MK et al (1998) Late effects of treatment for early-stage Hodgkin’s disease. Br J Cancer 77:1300–1310

    Article  PubMed  CAS  Google Scholar 

  • Byhardt RW, Martin L, Pajak TF et al (1993) The influence of field size and other treatment factors on pulmonary toxicity following hyperfractionated irradiation for inoperable non-small cell lung cancer (NSCLC)–analysis of a Radiation Therapy Oncology Group (RTOG) protocol. Int J Radiat Oncol Biol Phys 27:537–544

    Article  PubMed  CAS  Google Scholar 

  • Capizzi RL (1999) Amifostine reduces the incidence of cumulative nephrotoxicity from cisplatin: laboratory and clinical aspects. Semin Oncol 26:72–81

    PubMed  CAS  Google Scholar 

  • Carmel RJ, Kaplan HS (1976) Mantle irradiation in Hodgkin’s disease. An analysis of technique, tumor eradication, and complications. Cancer 37:2813–2825

    Article  PubMed  CAS  Google Scholar 

  • Chen Y, Williams J, Ding I et al (2002) Radiation pneumonitis and early circulatory cytokine markers. Semin Radiat Oncol 12:26–33

    Article  PubMed  Google Scholar 

  • Choi NC, Kanarek DJ (1994) Toxicity of thoracic radiotherapy on pulmonary function in lung cancer. Lung Cancer 10(Suppl 1):219–230

    Article  Google Scholar 

  • Constine LS, Schwartz RG, Savage DE et al (1997) Cardiac function, perfusion, and morbidity in irradiated long-term survivors of Hodgkin’s disease. Int J Radiat Oncol Biol Phys 39:897–906

    Article  PubMed  CAS  Google Scholar 

  • Cosset JM, Henry-Amar M, Girinski T et al (1988) Late toxicity of radiotherapy in Hodgkin’s disease. The role of fraction size. Acta Oncol 27:123–129

    Article  CAS  Google Scholar 

  • Cosset JM, Henry-Amar M, Pellae-Cosset B et al (1991) Pericarditis and myocardial infarctions after Hodgkin’s disease therapy. Int J Radiat Oncol Biol Phys 21:447–449

    Article  PubMed  CAS  Google Scholar 

  • Curran WJ, Moldofsky PJ, Solin LJ (1992) Observations on the predictive value of perfusion lung scans on post-irradiation pulmonary function among 210 patients with bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 24:31–36

    Article  PubMed  Google Scholar 

  • Cuzick J, Stewart H, Peto R et al (1987) Overview of randomized trials of postoperative adjuvant radiotherapy in breast cancer. Cancer Treat Rep 71:15–29

    PubMed  CAS  Google Scholar 

  • Cuzick J, Stewart H, Rutqvist L et al (1994) Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol 12:447–453

    PubMed  CAS  Google Scholar 

  • Das SK, Bell M, Marks LB et al (2004) A preliminary study of the role of modulated electron beams in intensity modulated radiotherapy, using automated beam orientation and modality selection. Int J Radiat Oncol Biol Phys 59:602–617

    Article  PubMed  Google Scholar 

  • Dautzenberg B, Arriagada R, Chammard AB et al (1999) A controlled study of postoperative radiotherapy for patients with completely resected nonsmall cell lung carcinoma. Groupe d’Etude et de Traitement des Cancers Bronchiques. Cancer 86:265–273

    Article  PubMed  CAS  Google Scholar 

  • De Ruysscher D, Wanders S, van Haren E et al (2005) Selective mediastinal node irradiation based on FDG-PET scan data in patients with non-small-cell lung cancer: a prospective clinical study. Int J Radiat Oncol Biol Phys 62:988–994

    Article  PubMed  Google Scholar 

  • Dechambre St, Dorzee J, Fastrez J et al (1998) Bronchial stenosis and sclerosing mediastinitis: an uncommon complication of external thoracic radiotherapy. Eur Respir J 11:1188–1190

    Article  PubMed  CAS  Google Scholar 

  • Dillman RO, Seagren SL, Propert KJ et al (1990) A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small-cell lung cancer. N Engl J Med 323:940–945

    Article  PubMed  CAS  Google Scholar 

  • Early Breast Cancer Trialists’ Collaborative Group (1990) Treatment of early breast cancer. vol 1. Oxford University, UK

    Google Scholar 

  • Early Breast Cancer Trialists’ Collaborative Group (1995) Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med 333:1444−1455

    Google Scholar 

  • Early Breast Cancer Trialists’ Collaborative Group (2000) Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 355:1757−1770

    Google Scholar 

  • Epperly MW, Travis EL, Sikora C et al (1999) Manganese [correction of Magnesium] superoxide dismutase (MnSOD) plasmid/liposome pulmonary radioprotective gene therapy: modulation of irradiation-induced mRNA for IL-I, TNF-alpha, and TGF-beta correlates with delay of organizing alveolitis/fibrosis. Biol Blood Marrow Transplant 5:204–214

    Article  PubMed  CAS  Google Scholar 

  • Evans ES, Kocak Z, Zhou S-M et al (2006) Does transforming growth factor-beta1 predict for radiation-induced pneumonitis in patients treated for lung cancer? Cytokine 35:186–192

    Article  PubMed  CAS  Google Scholar 

  • Fan M, Marks LB, Hollis D et al (2001) Can we predict radiation-induced changes in pulmonary function based on the sum of predicted regional dysfunction? J Clin Oncol 19:543–550

    PubMed  CAS  Google Scholar 

  • Favaretto A, Paccagnella A, Tomio L et al (1996) Pre-operative chemoradiotherapy in non-small cell lung cancer stage III patients. Feasibility, toxicity and long-term results of a phase II study. Eur J Cancer 32A:2064–2069

    Article  PubMed  CAS  Google Scholar 

  • Finkelstein JN, Johnston CJ, Baggs R et al (1994) Early alterations in extracellular matrix and transforming growth factor beta gene expression in mouse lung indicative of late radiation fibrosis. Int J Radiat Oncol Biol Phys 28:621–631

    Article  PubMed  CAS  Google Scholar 

  • Ford EC, Mageras GS, Yorke E et al (2002) Evaluation of respiratory movement during gated radiotherapy using film and electronic portal imaging. Int J Radiat Oncol Biol Phys 52:522–531

    Article  PubMed  CAS  Google Scholar 

  • Franko AJ, Sharplin J, Ghahary A et al (1997) Immunohistochemical localization of transforming growth factor beta and tumor necrosis factor alpha in the lungs of fibrosis-prone and “non-fibrosing” mice during the latent period and early phase after irradiation. Radiat Res 147:245–256

    Article  PubMed  CAS  Google Scholar 

  • Fu XL, Jiang GL, Wang LJ et al (1997) Hyperfractionated accelerated radiation therapy for non-small cell lung cancer: clinical phase I/II trial. Int J Radiat Oncol Biol Phys 39:545–552

    Article  PubMed  CAS  Google Scholar 

  • Fu XL, Huang H, Bentel G et al (2001) Predicting the risk of symptomatic radiation-induced lung injury using both the physical and biologic parameters V(30) and transforming growth factor beta. Int J Radiat Oncol Biol Phys 50:899–908

    Article  PubMed  CAS  Google Scholar 

  • Furuse K, Fukuoka M, Kawahara M et al (1999) Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol 17:2692–2699

    PubMed  CAS  Google Scholar 

  • Garipagaoglu M, Munley MT, Hollis D et al (1999) The effect of patient-specific factors on radiation-induced regional lung injury. Int J Radiat Oncol Biol Phys 45:331–338

    Article  PubMed  CAS  Google Scholar 

  • Geist BJ, Lauk S, Bornhausen M et al (1990) Physiologic consequences of local heart irradiation in rats. Int J Radiat Oncol Biol Phys 18:1107–1113

    Article  PubMed  CAS  Google Scholar 

  • Gomez GA, Park JJ, Panahon AM et al (1983) Heart size and function after radiation therapy to the mediastinum in patients with Hodgkin’s disease. Cancer Treat Rep 67:1099–1103

    PubMed  CAS  Google Scholar 

  • Gottdiener JS, Katin MJ, Borer JS et al (1983) Late cardiac effects of therapeutic mediastinal irradiation. Assessment by echocardiography and radionuclide angiography. N Engl J Med 308:569–572

    Article  PubMed  CAS  Google Scholar 

  • Graham MV, Purdy JA, Emami B et al (1999) Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 45:323–329

    Article  PubMed  CAS  Google Scholar 

  • Graves PR, Siddiqui F, Anscher MS et al (2010) Radiation Pulmonary Toxicity: from Mechanisms to Management. Semin Radiat Oncol 20:201–207

    Article  PubMed  Google Scholar 

  • Grills IS, Yan D, Martinez AA et al (2003) Potential for reduced toxicity and dose escalation in the treatment of inoperable non-small-cell lung cancer: a comparison of intensity-modulated radiation therapy (IMRT), 3D conformal radiation, and elective nodal irradiation. Int J Radiat Oncol Biol Phys 57:875–890

    Article  PubMed  Google Scholar 

  • Gross NJ (1977) Pulmonary effects of radiation therapy. Ann Intern Med 86:81–92

    Article  PubMed  CAS  Google Scholar 

  • Gross NJ (1980) Experimental radiation pneumonitis. IV. Leakage of circulatory proteins onto the alveolar surface. J Lab Clin Med 95:19–31

    PubMed  CAS  Google Scholar 

  • Gustavsson A, Eskilsson J, Landberg T et al (1990) Late cardiac effects after mantle radiotherapy in patients with Hodgkin’s disease. Ann Oncol 1:355–363

    PubMed  CAS  Google Scholar 

  • Gyenes G (1998) Radiation-induced ischemic heart disease in breast cancer–a review. Acta Oncol 37:241–246

    Article  PubMed  CAS  Google Scholar 

  • Gyenes G, Rutqvist LE, Liedberg A et al (1998) Long-term cardiac morbidity and mortality in a randomized trial of pre- and postoperative radiation therapy versus surgery alone in primary breast cancer. Radiother Oncol 48:185–190

    Article  PubMed  CAS  Google Scholar 

  • Hallahan DE, Spriggs DR, Beckett MA et al (1989) Increased tumor necrosis factor alpha mRNA after cellular exposure to ionizing radiation. Proc Natl Acad Sci U S A 86:10104–10107

    Article  PubMed  CAS  Google Scholar 

  • Hallahan DE, Virudachalam S, Beckett M et al (1991) Mechanisms of X-ray-mediated protooncogene c-jun expression in radiation-induced human sarcoma cell lines. Int J Radiat Oncol Biol Phys 21:1677–1681

    Article  PubMed  CAS  Google Scholar 

  • Hallahan DE, Virudachalam S, Kufe DW et al (1994) Ketoconazole attenuates radiation-induction of tumor necrosis factor. Int J Radiat Oncol Biol Phys 29:777–780

    Article  PubMed  CAS  Google Scholar 

  • Hancock SL, Hoppe RT (1996) Long-Term Complications of Treatment and Causes of Mortality After Hodgkin’s Disease. Semin Radiat Oncol 6:225–242

    Article  PubMed  Google Scholar 

  • Hancock SL, Donaldson SS, Hoppe RT (1993a) Cardiac disease following treatment of Hodgkin’s disease in children and adolescents. J Clin Oncol 11:1208–1215

    PubMed  CAS  Google Scholar 

  • Hancock SL, Tucker MA, Hoppe RT (1993b) Factors affecting late mortality from heart disease after treatment of Hodgkin’s disease. Jama 270:1949–1955

    Article  PubMed  CAS  Google Scholar 

  • Hardenbergh PH, Munley MT, Bentel GC et al (2001) Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: preliminary results. Int J Radiat Oncol Biol Phys 49:1023–1028

    Article  PubMed  CAS  Google Scholar 

  • Haston CK, Zhou X, Gumbiner-Russo L et al (2002) Universal and radiation-specific loci influence murine susceptibility to radiation-induced pulmonary fibrosis. Cancer Res 62:3782–3788

    PubMed  CAS  Google Scholar 

  • Henry-Amar M, Hayat M, Meerwaldt JH et al (1990) Causes of death after therapy for early stage Hodgkin’s disease entered on EORTC protocols. EORTC Lymphoma Cooperative Group. Int J Radiat Oncol Biol Phys 19:1155–1157

    Article  PubMed  CAS  Google Scholar 

  • Hernando ML, Marks LB, Bentel GC et al (2001) Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer. Int J Radiat Oncol Biol Phys 51:650–659

    Article  PubMed  CAS  Google Scholar 

  • Hong JH, Chiang CS, Campbell IL et al (1995) Induction of acute phase gene expression by brain irradiation. Int J Radiat Oncol Biol Phys 33:619–626

    Article  PubMed  CAS  Google Scholar 

  • Hong JH, Chiang CS, Sun JR et al (1997) Induction of c-fos and junB mRNA following in vivo brain irradiation. Brain Res Mol Brain Res 48:223–228

    Article  PubMed  CAS  Google Scholar 

  • Host H, Brennhovd IO, Loeb M (1986) Postoperative radiotherapy in breast cancer–long-term results from the Oslo study. Int J Radiat Oncol Biol Phys 12:727–732

    Article  PubMed  CAS  Google Scholar 

  • Hull MC, Morris CG, Pepine CJ et al (2003) Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lymphoma treated with radiation therapy. Jama 290:2831–2837

    Article  PubMed  CAS  Google Scholar 

  • Inoue A, Kunitoh H, Sekine I et al (2001) Radiation pneumonitis in lung cancer patients: a retrospective study of risk factors and the long-term prognosis. Int J Radiat Oncol Biol Phys 49:649–655

    Article  PubMed  CAS  Google Scholar 

  • Jakacki RI, Goldwein JW, Larsen RL et al (1993) Cardiac dysfunction following spinal irradiation during childhood. J Clin Oncol 11:1033–1038

    PubMed  CAS  Google Scholar 

  • Jin H, Tucker SL, Liu HH et al (2009) Dose–volume thresholds and smoking status for the risk of treatment-related pneumonitis in inoperable non-small cell lung cancer treated with definitive radiotherapy. Radiother Oncol 91:427–432

    Article  PubMed  Google Scholar 

  • Jiresova A, Wiegman EM, Kampinga HH et al (2002) Dose-volume-region effects in partial irradiation of the rat lung. Programs Abstr Radiat Res Soc North Am Hyperth Soc 103:114

    Google Scholar 

  • Johansson S, Bjermer L, Franzen L et al (1998) Effects of ongoing smoking on the development of radiation-induced pneumonitis in breast cancer and oesophagus cancer patients. Radiother Oncol 49:41–47

    Article  PubMed  CAS  Google Scholar 

  • Johnston CJ, Williams JP, Okunieff P et al (2002) Radiation-induced pulmonary fibrosis: examination of chemokine and chemokine receptor families. Radiat Res 157:256–265

    Article  PubMed  CAS  Google Scholar 

  • Jones JM, Ribeiro GG (1989) Mortality patterns over 34 years of breast cancer patients in a clinical trial of post-operative radiotherapy. Clin Radiol 40:204–208

    Article  PubMed  CAS  Google Scholar 

  • Katzenstein A-LA, Askin FB (2006) Katzenstein and Askin’s surgical pathology of non-neoplastic lung disease, 4th edn. Elsevier Saunders, Philadelphia

    Google Scholar 

  • Kelly K, Pan Z, Murphy J et al (1997) A phase I trial of paclitaxel plus carboplatin in untreated patients with advanced non-small cell lung cancer. Clin Cancer Res 3:1117–1123

    PubMed  CAS  Google Scholar 

  • Komaki R, Lee JS, Kaplan B et al (2002) Randomized phase III study of chemoradiation with or without amifostine for patients with favorable performance status inoperable stage II-III non-small cell lung cancer: preliminary results. Semin Radiat Oncol 12:46–49

    Article  PubMed  CAS  Google Scholar 

  • Kwon HC, Kim SK, Chung WK et al (2000) Effect of pentoxifylline on radiation response of non-small cell lung cancer: a phase III randomized multicenter trial. Radiother Oncol 56:175–179

    Article  PubMed  CAS  Google Scholar 

  • Lagrange JL, Darcourt J, Benoliel J et al (1992) Acute cardiac effects of mediastinal irradiation: assessment by radionuclide angiography. Int J Radiat Oncol Biol Phys 22:897–903

    Article  PubMed  CAS  Google Scholar 

  • Lauk S, Trott KR (1988) Radiation induced heart disease in hypertensive rats. Int J Radiat Oncol Biol Phys 14:109–114

    Article  PubMed  CAS  Google Scholar 

  • Liao ZX, Komaki RR, Thames HD Jr et al (2010) Influence of technologic advances on outcomes in patients with unresectable, locally advanced non–small-cell lung cancer receiving concomitant chemoradiotherapy. Int J Radiat Oncol Bio Phys 76:775–781

    Article  Google Scholar 

  • Libshitz HI, Shuman LS (1984) Radiation-induced pulmonary change: CT findings. J Comput Assist Tomogr 8:15–19

    Article  PubMed  Google Scholar 

  • Lind PA, Marks LB, Hollis D et al (2002) Receiver operating characteristic curves to assess predictors of radiation-induced symptomatic lung injury. Int J Radiat Oncol Biol Phys 54:340–347

    Article  PubMed  Google Scholar 

  • Maguire PD, Marks LB, Sibley GS et al (2001) 73.6 Gy and beyond: hyperfractionated, accelerated radiotherapy for non-small-cell lung cancer. J Clin Oncol 19:705–711

    PubMed  CAS  Google Scholar 

  • Mah K, Poon PY, Van Dyk J et al (1986) Assessment of acute radiation-induced pulmonary changes using computed tomography. J Comput Assist Tomogr 10:736–743

    Article  PubMed  CAS  Google Scholar 

  • Mah K, Van Dyk J, Keane T et al (1987) Acute radiation-induced pulmonary damage: a clinical study on the response to fractionated radiation therapy. Int J Radiat Oncol Biol Phys 13:179–188

    Article  PubMed  CAS  Google Scholar 

  • Mah K, Keane TJ, Van Dyk J et al (1994) Quantitative effect of combined chemotherapy and fractionated radiotherapy on the incidence of radiation-induced lung damage: a prospective clinical study. Int J Radiat Oncol Biol Phys 28:563–574

    Article  PubMed  CAS  Google Scholar 

  • Makimoto T, Tsuchiya S, Hayakawa K et al (1999) Risk factors for severe radiation pneumonitis in lung cancer. Jpn J Clin Oncol 29:192–197

    Article  PubMed  CAS  Google Scholar 

  • Makinen L, Makipernaa A, Rautonen J et al (1990) Long-term cardiac sequelae after treatment of malignant tumors with radiotherapy or cytostatics in childhood. Cancer 65:1913–1917

    Article  PubMed  CAS  Google Scholar 

  • Marks LB, Spencer DP, Bentel GC et al (1993) The utility of SPECT lung perfusion scans in minimizing and assessing the physiologic consequences of thoracic irradiation. Int J Radiat Oncol Biol Phys 26:659–668

    Article  PubMed  CAS  Google Scholar 

  • Marks LB, Hollis D, Munley M et al (2000) The role of lung perfusion imaging in predicting the direction of radiation-induced changes in pulmonary function tests. Cancer 88:2135–2141

    Article  PubMed  CAS  Google Scholar 

  • Marks LB, Yu X, Zhou S (2003) The impact of irradiated left ventricular volume on the incidence of radiation-induced cardiac perfusion changes. Int J Radiat Oncol Biol Phys 57:S129

    Article  Google Scholar 

  • Marks LB, Bentzen SM, Deasy JO et al (2010) Radiation dose-volume effects in the lung. Int J Radiat Oncol Biol Phys 76:S70–S76

    Article  PubMed  Google Scholar 

  • Marnitz S, Stuschke M, Bohsung J et al (2002) Intraindividual comparison of conventional three-dimensional radiotherapy and intensity modulated radiotherapy in the therapy of locally advanced non-small cell lung cancer a planning study. Strahlenther Onkol 178:651–658

    Article  PubMed  Google Scholar 

  • Martel MK, Ten Haken RK, Hazuka MB et al (1994) Dose-volume histogram and 3D treatment planning evaluation of patients with pneumonitis. Int J Radiat Oncol Biol Phys 28:575–581

    Article  PubMed  CAS  Google Scholar 

  • Mattson K, Holsti LR, Poppius H et al (1987) Radiation pneumonitis and fibrosis following split-course radiation therapy for lung cancer. A radiologic and physiologic study. Acta Oncol 26:193–196

    Article  PubMed  CAS  Google Scholar 

  • McDonald S, Rubin P, Phillips TL et al (1995) Injury to the lung from cancer therapy: clinical syndromes, measurable endpoints, and potential scoring systems. Int J Radiat Oncol Biol Phys 31:1187–1203

    Article  PubMed  CAS  Google Scholar 

  • Miller KL, Shafman TD, Anscher MS et al (2005) Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer? Int J Radiat Oncol Biol Phys 61:64–69

    Article  PubMed  Google Scholar 

  • Monson JM, Stark P, Reilly JJ et al (1998) Clinical radiation pneumonitis and radiographic changes after thoracic radiation therapy for lung carcinoma. Cancer 82:842–850

    Article  PubMed  CAS  Google Scholar 

  • Morgan GW, Breit SN (1995) Radiation and the lung: a reevaluation of the mechanisms mediating pulmonary injury. Int J Radiat Oncol Biol Phys 31:361–369

    Article  PubMed  CAS  Google Scholar 

  • Ng AK, Bernardo MP, Weller E et al (2002) Long-term survival and competing causes of death in patients with early-stage Hodgkin’s disease treated at age 50 or younger. J Clin Oncol 20:2101–2108

    Article  PubMed  Google Scholar 

  • Nyman J, Bergman B, Mercke C (1998) Accelerated hyperfractionated radiotherapy combined with induction and concomitant chemotherapy for inoperable non-small-cell lung cancer–impact of total treatment time. Acta Oncol 37:539–545

    Article  PubMed  CAS  Google Scholar 

  • Oetzel D, Schraube P, Hensley F et al (1995) Estimation of pneumonitis risk in three-dimensional treatment planning using dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 33:455–460

    Article  PubMed  CAS  Google Scholar 

  • Overgaard M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 337:949–955

    Article  PubMed  CAS  Google Scholar 

  • Overgaard M, Jensen MB, Overgaard J et al (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 353:1641–1648

    Article  PubMed  CAS  Google Scholar 

  • Paszat LF, Mackillop WJ, Groome PA et al (1998) Mortality from myocardial infarction after adjuvant radiotherapy for breast cancer in the surveillance, epidemiology, and end-results cancer registries. J Clin Oncol 16:2625–2631

    PubMed  CAS  Google Scholar 

  • Perez CA, Stanley K, Rubin P et al (1980) A prospective randomized study of various irradiation doses and fractionation schedules in the treatment of inoperable non-oat-cell carcinoma of the lung. Preliminary report by the Radiation Therapy Oncology Group. Cancer 45:2744–2753

    Article  PubMed  CAS  Google Scholar 

  • Perry MC, Eaton WL, Propert KJ et al (1987) Chemotherapy with or without radiation therapy in limited small-cell carcinoma of the lung. N Engl J Med 316:912–918

    Article  PubMed  CAS  Google Scholar 

  • Pohjola-Sintonen S, Totterman KJ, Salmo M et al (1987) Late cardiac effects of mediastinal radiotherapy in patients with Hodgkin’s disease. Cancer 60:31–37

    Article  PubMed  CAS  Google Scholar 

  • PORT Meta-analysis Trialists Group (1998) Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. Lancet 352:257−263

    Google Scholar 

  • Prato FS, Kurdyak R, Saibil EA et al (1977) Physiological and radiographic assessment during the development of pulmonary radiation fibrosis. Radiology 122:389–397

    PubMed  CAS  Google Scholar 

  • Prosnitz RG, Hubbs JL, Evans ES et al (2007) Prospective assessment of radiotherapy-associated cardiac toxicity in breast cancer patients: analysis of data 3 to 6 years after treatment. Cancer 110:1840–1850

    Article  PubMed  Google Scholar 

  • Ragaz J, Jackson SM, Le N et al (1997) Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337:956–962

    Article  PubMed  CAS  Google Scholar 

  • Roach M, Gandara DR, Yuo HS et al (1995) Radiation pneumonitis following combined modality therapy for lung cancer: analysis of prognostic factors. J Clin Oncol 13:2606–2612

    PubMed  Google Scholar 

  • Robnett TJ, Machtay M, Vines EF et al (2000) Factors predicting severe radiation pneumonitis in patients receiving definitive chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys 48:89–94

    Article  PubMed  CAS  Google Scholar 

  • Rosenzweig KE, Sim SE, Mychalczak B et al (2001) Elective nodal irradiation in the treatment of non-small-cell lung cancer with three-dimensional conformal radiation therapy. Int J Radiat Oncol Biol Phys 50:681–685

    Article  PubMed  CAS  Google Scholar 

  • Roswit B, White DC (1977) Severe radiation injuries of the lung. AJR Am J Roentgenol 129:127–136

    Article  PubMed  CAS  Google Scholar 

  • Rubenstein JH, Richter MP, Moldofsky PJ et al (1988) Prospective prediction of post-radiation therapy lung function using quantitative lung scans and pulmonary function testing. Int J Radiat Oncol Biol Phys 15:83–87

    Article  PubMed  CAS  Google Scholar 

  • Rubin P, Shapiro DL, Finklestein JN et al (1980) The early release of surfactant following lung irradiation of alveolar type II cells. Int J Radiat Oncol Biol Phys 6:75–77

    Article  PubMed  CAS  Google Scholar 

  • Rubin P, Siemann DW, Shapiro DL et al (1983) Surfactant release as an early measure of radiation pneumonitis. Int J Radiat Oncol Biol Phys 9:1669–1673

    Article  PubMed  CAS  Google Scholar 

  • Rubin P, Johnston CJ, Williams JP et al (1995) A perpetual cascade of cytokines postirradiation leads to pulmonary fibrosis. Int J Radiat Oncol Biol Phys 33:99–109

    Article  PubMed  CAS  Google Scholar 

  • Rutqvist LE, Johansson H (1990) Mortality by laterality of the primary tumour among 55, 000 breast cancer patients from the Swedish Cancer Registry. Br J Cancer 61:866–868

    Article  PubMed  CAS  Google Scholar 

  • Rutqvist LE, Lax I, Fornander T et al (1992) Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys 22:887–896

    Article  PubMed  CAS  Google Scholar 

  • Segawa Y, Takigawa N, Kataoka M et al (1997) Risk factors for development of radiation pneumonitis following radiation therapy with or without chemotherapy for lung cancer. Int J Radiat Oncol Biol Phys 39:91–98

    Article  PubMed  CAS  Google Scholar 

  • Seppenwoolde Y, Muller SH, Theuws JC et al (2000) Radiation dose-effect relations and local recovery in perfusion for patients with non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 47:681–690

    Article  PubMed  CAS  Google Scholar 

  • Seppenwoolde Y, Engelsman M, De Jaeger K et al (2002) Optimizing radiation treatment plans for lung cancer using lung perfusion information. Radiother Oncol 63:165–177

    Article  PubMed  Google Scholar 

  • Shapiro SJ, Shapiro SD, Mill WB et al (1990) Prospective study of long-term pulmonary manifestations of mantle irradiation. Int J Radiat Oncol Biol Phys 19:707–714

    Article  PubMed  CAS  Google Scholar 

  • Simpson JR, Francis ME, Perez-Tamayo R et al (1985) Palliative radiotherapy for inoperable carcinoma of the lung: final report of a RTOG multi-institutional trial. Int J Radiat Oncol Biol Phys 11:751–758

    Article  PubMed  CAS  Google Scholar 

  • Strender LE, Lindahl J, Larsson LE (1986) Incidence of heart disease and functional significance of changes in the electrocardiogram 10 years after radiotherapy for breast cancer. Cancer 57:929–934

    Article  PubMed  CAS  Google Scholar 

  • Sunyach MP, Falchero L, Pommier P et al (2000) Prospective evaluation of early lung toxicity following three-dimensional conformal radiation therapy in non-small-cell lung cancer: preliminary results. Int J Radiat Oncol Biol Phys 48:459–463

    Article  PubMed  CAS  Google Scholar 

  • Swerdlow AJ, Higgins CD, Smith P et al (2007) Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. J Natl Cancer Inst 99:206–214

    Article  PubMed  Google Scholar 

  • Theuws JC, Kwa SL, Wagenaar AC et al (1998a) Prediction of overall pulmonary function loss in relation to the 3D dose distribution for patients with breast cancer and malignant lymphoma. Radiother Oncol 49:233–243

    Article  PubMed  CAS  Google Scholar 

  • Theuws JC, Kwa SL, Wagenaar AC et al (1998b) Dose-effect relations for early local pulmonary injury after irradiation for malignant lymphoma and breast cancer. Radiother Oncol 48:33–43

    Article  PubMed  CAS  Google Scholar 

  • Travis EL (1980) The sequence of histological changes in mouse lungs after single doses of x-rays. Int J Radiat Oncol Biol Phys 6:345–347

    Article  PubMed  CAS  Google Scholar 

  • Travis EL, Harley RA, Fenn JO et al (1977) Pathologic changes in the lung following single and multi-fraction irradiation. Int J Radiat Oncol Biol Phys 2:475–490

    Article  PubMed  CAS  Google Scholar 

  • Travis EL, Liao ZX, Tucker SL (1997) Spatial heterogeneity of the volume effect for radiation pneumonitis in mouse lung. Int J Radiat Oncol Biol Phys 38:1045–1054

    Article  PubMed  CAS  Google Scholar 

  • Tsujino K, Hirota S, Endo M et al (2003) Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys 55:110–115

    Article  PubMed  Google Scholar 

  • Tucker SL, Liao ZX, Travis EL (1997) Estimation of the spatial distribution of target cells for radiation pneumonitis in mouse lung. Int J Radiat Oncol Biol Phys 38:1055–1066

    Article  PubMed  CAS  Google Scholar 

  • Tucker SL, Jin H, Wei X et al (2010) Impact of Toxicity Grade and Scoring System on the Relationship Between Mean Lung Dose and Risk of Radiation Pneumonitis in a Large Cohort of Patients With Non–Small Cell Lung Cancer. Int J Radiat Oncol Bio Phys 77:691–698

    Article  Google Scholar 

  • Van den Brande P, De Ruysscher D, Vansteenkiste J et al (1998) Sequential treatment with vindesine-ifosfamide-platinum (VIP) chemotherapy followed by platinum sensitized radiotherapy in stage IIIB non-small cell lung cancer: a phase II trial. Lung Cancer 22:45–53

    Article  PubMed  Google Scholar 

  • Van Dyk J, Keane TJ, Kan S et al (1981) Radiation pneumonitis following large single dose irradiation: a re-evaluation based on absolute dose to lung. Int J Radiat Oncol Biol Phys 7:461–467

    Article  PubMed  Google Scholar 

  • van Loon J, De Ruysscher D, Wanders R et al (2010) Selective nodal irradiation on basis of (18)FDG-PET scans in limited-disease small-cell lung cancer: a prospective study. Int J Radiat Oncol Biol Phys 77:329–336

    Article  PubMed  Google Scholar 

  • van Rijswijk RE, Verbeek J, Haanen C et al (1987) Major complications and causes of death in patients treated for Hodgkin’s disease. J Clin Oncol 5:1624–1633

    PubMed  Google Scholar 

  • Vogt HG, Kolotas C, Martin T et al (1996) Simultaneous radiochemotherapy with paclitaxel in non-small cell lung cancer: a clinical phase I study. Semin Oncol 23:26–30

    PubMed  CAS  Google Scholar 

  • Wasserman T (1999) Radioprotective effects of amifostine. Semin Oncol 26:89–94

    PubMed  CAS  Google Scholar 

  • Watchie J, Coleman CN, Raffin TA et al (1987) Minimal long-term cardiopulmonary dysfunction following treatment for Hodgkin’s disease. Int J Radiat Oncol Biol Phys 13:517–524

    Article  PubMed  CAS  Google Scholar 

  • Werner-Wasik M, Scott C, Movsas B et al (2003) Amifostine as mucosal protectant in patients with locally advanced non-small cell lung cancer (NSCLC) receiving intensive chemotherapy and thoracic radiotherapy (RT): results of the Radiation Therapy Oncology Group (RTOG) 98-01 study. Int J Radiat Oncol Biol Phys 57:S216

    Google Scholar 

  • Whelan TJ, Julian J, Wright J et al (2000) Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol 18:1220–1229

    PubMed  CAS  Google Scholar 

  • Willner J, Jost A, Baier K et al (2003) A little to a lot or a lot to a little? An analysis of pneumonitis risk from dose-volume histogram parameters of the lung in patients with lung cancer treated with 3D conformal radiotherapy. Strahlenther Onkol 179:548–556

    Article  PubMed  Google Scholar 

  • Woel RT, Munley MT, Hollis D et al (2002) The time course of radiation therapy-induced reductions in regional perfusion: a prospective study with >5 years of follow-up. Int J Radiat Oncol Biol Phys 52:58–67

    Article  PubMed  Google Scholar 

  • Yamada M, Kudoh S, Hirata K et al (1998) Risk factors of pneumonitis following chemoradiotherapy for lung cancer. Eur J Cancer 34:71–75

    Article  PubMed  CAS  Google Scholar 

  • Yin L, Shcherbinin S, Celler A et al (2010) Incorporating quantitative single photon emission computed tomography into radiation therapy treatment planning for lung cancer: impact of attenuation and scatter correction on the single photon emission computed tomography–weighted mean dose and functional lung segmentation. Int J Radiat Oncol Bio Phys 78:587–594

    Article  Google Scholar 

  • Yom SS, Liao Z, Liu HH et al (2007) Initial evaluation of treatment-related pneumonitis in advanced-stage non–small-cell lung cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Bio Phys 68:94–102

    Article  CAS  Google Scholar 

  • Yorke ED, Jackson A, Rosenzweig KE et al (2002a) Dose-volume factors contributing to the incidence of radiation pneumonitis in non-small-cell lung cancer patients treated with three-dimensional conformal radiation therapy. Int J Radiat Oncol Biol Phys 54:329–339

    Article  PubMed  Google Scholar 

  • Yorke ED, Jackson A, Rosenzweig KE (2002b) Dose-volume factors contributing to the incidence of radiation pneumonitis in non-small-cell lung cancer patients treated with three-dimensional conformal radiation therapy. Int J Radiat Oncol Biol Phys 54:329–339

    Article  PubMed  Google Scholar 

  • Yorke ED, Wang L, Rosenzweig KE et al (2002c) Evaluation of deep inspiration breath-hold lung treatment plans with Monte Carlo dose calculation. Int J Radiat Oncol Biol Phys 53:1058–1070

    Article  PubMed  Google Scholar 

  • Yu X, Prosnitz RR, Zhou S et al (2003) Symptomatic cardiac events following radiation therapy for left-sided breast cancer: possible association with radiation therapy-induced changes in regional perfusion. Clin Breast Cancer 4:193–197

    PubMed  Google Scholar 

  • Zhao L, Wang L, Ji W et al (2009) Elevation of plasma TGF-beta1 during radiation therapy predicts radiation-induced lung toxicity in patients with non-small-cell lung cancer: a combined analysis from Beijing and Michigan. Int J Radiat Oncol Biol Phys 74:1385–1390

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

This work was supported by NIH Grant 2R201 CA69579-09.

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Xie, L. et al. (2011). Radiation-Induced Lung and Heart Toxicity. In: Jeremic, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_273

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