Bronchial stenosis

An underreported complication of high-dose external beam radiotherapy for lung cancer?

Keith L. Miller, Timothy D. Shafman, Mitchell S. Anscher, Sumin Zhou, Robert W. Clough, Jennifer L. Garst, Jeffrey Crawford, Julian Rosenman, Mark A. Socinski, William Blackstock, Gregory S. Sibley, Lawrence B. Marks

Research output: Contribution to journalArticle

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Abstract

Purpose To assess the incidence of clinically significant bronchial stenosis in patients treated with high doses (i.e., >70 Gy) of twice-daily external beam radiation therapy (RT). Methods and materials The outcomes of 103 patients with unresectable non-small-cell lung cancer, treated twice daily to doses ranging from 7080 to 8640 cGy between 1992 and 2001, were analyzed. Most were treated on prospective clinical trials. For the dose-effect comparison, the patients were divided on the basis of the total dose: 67 received 74 Gy (range, 70.8-74.5 Gy; median, 73.6 Gy), 20 received 80 Gy, and 16 received 86 Gy (range, 85.2-86.4 Gy; median, 86.4 Gy). Sixty-six patients received sequential chemotherapy before RT. RT-induced bronchial stenosis was defined as symptomatic airway narrowing diagnosed by bronchoscopy or computed tomography scan without evidence of recurrent tumor in that region. Results Eight patients developed RT-induced, clinically significant, bronchial stenosis 2-48 months (median, 6 months) after RT. The 1-year and 4-year actuarial rate of stenosis was 7% and 38%, respectively. The median overall survival was 2.5 years (5 of 8 were alive at the writing of this report). A suggestion was also found of a dose-response effect with external beam radiotherapy-induced stenosis, with a rate of 4% and 25% at a dose of approximately 74 Gy and 86 Gy, respectively. Conclusion Radiation therapy-induced bronchial stenosis is a significant clinical complication of dose escalation for lung cancer. This complication has been previously mentioned in the literature, but ours is the largest report to date, and the findings suggest that the risk rises with increasing dose. It is likely that this process would manifest in more patients if their disease were controlled well enough for more prolonged survival.

Original languageEnglish (US)
Pages (from-to)64-69
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume61
Issue number1
DOIs
StatePublished - Jan 1 2005

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lungs
radiation therapy
Lung Neoplasms
Pathologic Constriction
Radiotherapy
cancer
dosage
Survival
Bronchoscopy
Non-Small Cell Lung Carcinoma
chemotherapy
suggestion
Tomography
Clinical Trials
tumors
incidence
tomography
Drug Therapy
Incidence
Neoplasms

Keywords

  • Bronchial stenosis
  • Dose escalation
  • Lung cancer
  • Radiotherapy

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Bronchial stenosis : An underreported complication of high-dose external beam radiotherapy for lung cancer? / Miller, Keith L.; Shafman, Timothy D.; Anscher, Mitchell S.; Zhou, Sumin; Clough, Robert W.; Garst, Jennifer L.; Crawford, Jeffrey; Rosenman, Julian; Socinski, Mark A.; Blackstock, William; Sibley, Gregory S.; Marks, Lawrence B.

In: International Journal of Radiation Oncology Biology Physics, Vol. 61, No. 1, 01.01.2005, p. 64-69.

Research output: Contribution to journalArticle

Miller, KL, Shafman, TD, Anscher, MS, Zhou, S, Clough, RW, Garst, JL, Crawford, J, Rosenman, J, Socinski, MA, Blackstock, W, Sibley, GS & Marks, LB 2005, 'Bronchial stenosis: An underreported complication of high-dose external beam radiotherapy for lung cancer?', International Journal of Radiation Oncology Biology Physics, vol. 61, no. 1, pp. 64-69. https://doi.org/10.1016/j.ijrobp.2004.02.066
Miller, Keith L. ; Shafman, Timothy D. ; Anscher, Mitchell S. ; Zhou, Sumin ; Clough, Robert W. ; Garst, Jennifer L. ; Crawford, Jeffrey ; Rosenman, Julian ; Socinski, Mark A. ; Blackstock, William ; Sibley, Gregory S. ; Marks, Lawrence B. / Bronchial stenosis : An underreported complication of high-dose external beam radiotherapy for lung cancer?. In: International Journal of Radiation Oncology Biology Physics. 2005 ; Vol. 61, No. 1. pp. 64-69.
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abstract = "Purpose To assess the incidence of clinically significant bronchial stenosis in patients treated with high doses (i.e., >70 Gy) of twice-daily external beam radiation therapy (RT). Methods and materials The outcomes of 103 patients with unresectable non-small-cell lung cancer, treated twice daily to doses ranging from 7080 to 8640 cGy between 1992 and 2001, were analyzed. Most were treated on prospective clinical trials. For the dose-effect comparison, the patients were divided on the basis of the total dose: 67 received 74 Gy (range, 70.8-74.5 Gy; median, 73.6 Gy), 20 received 80 Gy, and 16 received 86 Gy (range, 85.2-86.4 Gy; median, 86.4 Gy). Sixty-six patients received sequential chemotherapy before RT. RT-induced bronchial stenosis was defined as symptomatic airway narrowing diagnosed by bronchoscopy or computed tomography scan without evidence of recurrent tumor in that region. Results Eight patients developed RT-induced, clinically significant, bronchial stenosis 2-48 months (median, 6 months) after RT. The 1-year and 4-year actuarial rate of stenosis was 7{\%} and 38{\%}, respectively. The median overall survival was 2.5 years (5 of 8 were alive at the writing of this report). A suggestion was also found of a dose-response effect with external beam radiotherapy-induced stenosis, with a rate of 4{\%} and 25{\%} at a dose of approximately 74 Gy and 86 Gy, respectively. Conclusion Radiation therapy-induced bronchial stenosis is a significant clinical complication of dose escalation for lung cancer. This complication has been previously mentioned in the literature, but ours is the largest report to date, and the findings suggest that the risk rises with increasing dose. It is likely that this process would manifest in more patients if their disease were controlled well enough for more prolonged survival.",
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AU - Garst, Jennifer L.

AU - Crawford, Jeffrey

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AB - Purpose To assess the incidence of clinically significant bronchial stenosis in patients treated with high doses (i.e., >70 Gy) of twice-daily external beam radiation therapy (RT). Methods and materials The outcomes of 103 patients with unresectable non-small-cell lung cancer, treated twice daily to doses ranging from 7080 to 8640 cGy between 1992 and 2001, were analyzed. Most were treated on prospective clinical trials. For the dose-effect comparison, the patients were divided on the basis of the total dose: 67 received 74 Gy (range, 70.8-74.5 Gy; median, 73.6 Gy), 20 received 80 Gy, and 16 received 86 Gy (range, 85.2-86.4 Gy; median, 86.4 Gy). Sixty-six patients received sequential chemotherapy before RT. RT-induced bronchial stenosis was defined as symptomatic airway narrowing diagnosed by bronchoscopy or computed tomography scan without evidence of recurrent tumor in that region. Results Eight patients developed RT-induced, clinically significant, bronchial stenosis 2-48 months (median, 6 months) after RT. The 1-year and 4-year actuarial rate of stenosis was 7% and 38%, respectively. The median overall survival was 2.5 years (5 of 8 were alive at the writing of this report). A suggestion was also found of a dose-response effect with external beam radiotherapy-induced stenosis, with a rate of 4% and 25% at a dose of approximately 74 Gy and 86 Gy, respectively. Conclusion Radiation therapy-induced bronchial stenosis is a significant clinical complication of dose escalation for lung cancer. This complication has been previously mentioned in the literature, but ours is the largest report to date, and the findings suggest that the risk rises with increasing dose. It is likely that this process would manifest in more patients if their disease were controlled well enough for more prolonged survival.

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