Impact of Unsuccessful Steroid Tapering on Survival in Patients Treated for Radiation Pneumonitis Following Definitive Radiation for Non-Small Cell Lung Cancer.
Aya Ghaleb Hashim, Rasmus Froberg Brøndum, Martin Skovmos Nielsen, Kasper Lind Laursen, Sille Vestergaard, Wenja Heijkoop, Weronika Maria Szejniuk
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Abstract
Objectives: Radiation pneumonitis (RP) presents a significant concern in the management of patients with locally advanced non-small cell lung cancer (NSCLC) undergoing definitive radiation therapy (RT). This study aims to investigate the clinical implication of unsuccessful steroid tapering due to rebound of respiratory symptoms in patients diagnosed with RP.
Materials and methods: This retrospective analysis included NSCLC patients treated with definitive RT between 2010 and 2020. Clinical data, steroid treatment outcome for RP, progression and survival data were collected. Patients were stratified based on RP diagnosis and successful or unsuccessful tapering of steroids due to rebound of respiratory symptoms. Survival was estimated using Kaplan-Meier and log-rank analyses. Univariate and multivariate Cox regression analyses were performed, P-values < .05 were considered significant.
Results: The cohort consisted of 273 patients. About 30.4% of patients (n = 83) developed RP. In the RP-group, 22.9% (n = 19) experienced unsuccessful tapering of steroid due to rebound of respiratory symptoms. Median progression-free survival (PFS) and overall survival (OS) in those patients were 9.0 months (95% CI 6.4-13.8) and 22.2 months (95% CI 17.0-34.9) respectively, significantly shorter than median PFS of 14.8 months (95% CI 5.9-36.3) and OS of 43.4 months (95% CI 27.9-71.2) in patients with successful tapering. A multivariate Cox regression with time-varying covariates confirmed the significantly higher risk of progression and death in those patients.
Conclusion: Patients with RP who experienced unsuccessful tapering of steroids due to rebound of respiratory symptoms had a significantly higher risk of progression and death compared to RP patients with successful tapering of steroids. More frequent surveillance may be considered in those patients.
目的：放射性肺炎（RP）在局部晚期非小细胞肺癌（NSCLC）患者接受最终放射治疗（RT）时的管理中具有重要意义。本研究旨在探讨诊断为RP的患者因呼吸道症状反弹而导致类固醇减量不成功的临床意义。材料和方法：本回顾性分析包括2010年至2020年间接受明确RT治疗的非小细胞肺癌患者。收集临床数据、类固醇治疗RP的结果、进展和生存数据。根据RP诊断和因呼吸道症状反弹导致的类固醇减量成功或不成功对患者进行分层。使用Kaplan-Meier和log-rank分析估计生存率。进行单因素和多因素Cox回归分析，p值< 0.05为显著性。结果：该队列包括273例患者。约30.4%的患者（n = 83）发生RP。在rp组中，22.9% （n = 19）的患者由于呼吸道症状的反弹而逐渐减少类固醇治疗失败。这些患者的中位无进展生存期（PFS）和总生存期（OS）分别为9.0个月（95% CI 6.4-13.8）和22.2个月（95% CI 17.0-34.9），显著短于成功减量患者的中位PFS 14.8个月（95% CI 5.9-36.3）和OS 43.4个月（95% CI 27.9-71.2）。具有时变协变量的多变量Cox回归证实，这些患者的进展和死亡风险明显更高。结论：由于呼吸道症状反弹导致类固醇减量治疗失败的RP患者与类固醇减量治疗成功的RP患者相比，其进展和死亡的风险明显更高。这些患者可以考虑进行更频繁的监测。
期刊介绍：
Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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