Effect of postoperative radiotherapy on changes in pulmonary function in patients with stage II and IIIA lung carcinoma

Our plain-English summary of Effect of postoperative radiotherapy on changes in pulmonary function in patients with stage II and IIIA lung carcinoma, by N.C. Choi, D.J. Kanarek, H.C. Grillo (International Journal of Radiation Oncology, Biology, Physics, 1990).

The study

• Authors: N.C. Choi, D.J. Kanarek, H.C. Grillo
• Journal: International Journal of Radiation Oncology, Biology, Physics
• Published: 1990;18(1):95-9
• Cited by: 40 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

To assess the pulmonary tolerance to postoperative radiotherapy (RT) in patients with resected lung carcinoma, a prospective study was begun in January 1977, which consisted of (a) initial pulmonary function test (PFT) and arterial blood gases (ABG) at 1 month after surgery, and before beginning of postoperative RT, and (b) follow-up PFT and ABG 1 year after postoperative RT and then every year thereafter. As of December 1987, 137 patients have been enrolled into this study, and 71 patients who were free of recurrence were subjected to the follow-up PFT and ABG. The remaining 66 patients were unable to complete the follow-up studies because of recurrent carcinoma in 60, refusal to participate in the study in 5 patients even in the absence of significant respiratory symptoms, and progressive asbestos-related pleural thickening in 1 patient. The patient characteristics were as follows: Age ranged from 27 to 79 years with the median of 59 years; sex ratio was 1.4 to 1 for male to female; surgical procedures included lobectomy in 49 and pneumonectomy in 22 patients; tumor extent consisted of Stages T1-T2N1M0 in 44, T1-T2N2M0 in 9, and T3N0-N2M0 in 18 patients, respectively. Histologic types included squamous cell carcinoma in 26, adenocarcinoma in 42, small cell carcinoma in 1, and large cell carcinoma in 2 patients. Target volume for RT included the ipsilateral hilum, the mediastinum, and the thoracic inlet including both supraclavicular fossae. A total dose of 54 Gy was delivered in 1.8 Gy of daily fractions, 5 days per week over a period of 6 weeks. Contrary to expectation, there were minor changes in PFT indices in both lobectomy and pneumonectomy patients. The follow-up PFT in the lobectomy group showed small -3% to +2% changes in mean values of ventilatory indices, lung volume, and ABG. The follow-up PFT in the pneumonectomy group also showed small -9% to +13% changes in mean values of ventilatory indices, lung volume, and ABG. Sixteen patients have had more than one PFT during the follow-up period (2 years to 10 years), and there was no significant long term adverse effect of RT on PFT in this subset of patients. Lung scans assessing regional function, which were available in six patients, were not helpful in predicting changes in PFT indices as a result of postoperative RT.

In plain English

This prospective study measured lung function changes after radiotherapy following lung cancer surgery. Asbestos is mentioned only for one patient who could not complete follow-up because of progressive asbestos-related pleural thickening. Of 137 patients enrolled from 1977 to 1987, 71 free of recurrence had repeat tests (49 after lobectomy, 22 after pneumonectomy). Lung function and blood gases were tested before radiotherapy (54 Gy over 6 weeks) and 12 months after it started. Mean values changed by -3% to +2% after lobectomy and -9% to +13% after pneumonectomy. In 16 patients retested over 2 to 10 years, the authors said breathing measures 2 to 8 years after treatment were similar to those at 1 year. In six patients, a lung-scan formula predicted a mean 16.5% fall in FEV1 (a breathing measure); the measured mean change was -3.5%. Four of 137 patients had symptomatic lung toxicity; one later died of cardiac failure. The authors concluded that changes were minor in both groups. They defined no specific, consistent risk factors for lung toxicity but suggested marginal lung reserve as a possible one.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: prospective study of lung function before and after postoperative radiotherapy
• Who was studied: Patients referred for radiotherapy after surgery for lung carcinoma at Massachusetts General Hospital, January 1977 to December 1987. Of 150 referred, 137 were enrolled. 71 recurrence-free patients had follow-up tests: 49 after lobectomy and 22 after pneumonectomy, aged 27 to 79 (median 59).
• Exposure: Postoperative radiotherapy: a total of 54 Gy given in 1.8 Gy daily doses, 5 days a week for 6 weeks. Asbestos exposure was not studied.
• Main results:
  • Lobectomy group, 12 months after radiotherapy began: mean values of breathing measures, lung volume and blood gases changed by -3% to +2%.
  • Pneumonectomy group: mean values changed by -9% to +13%.
  • Sixteen patients had more than one repeat test during follow-up lasting 2 to 10 years. Their mean FEV1 was 1.82 L before radiotherapy, 1.87 L at 1 year and 1.92 L at 2.5 years.
  • The authors stated that breathing measures taken 2 to 8 years after treatment were similar to those at 1 year.
  • In six patients, the lung-scan prediction formula estimated a mean FEV1 fall of 16.5%. The measured mean change was -3.5%, and only 1 of the 6 patients showed agreement between the two.
  • In eight patients with markedly limited lung reserve (median FEV1 1.08 L before treatment), median FEV1 at follow-up was 1.17 L. Median PaO2 (oxygen in the blood) was 72 mm Hg before and 67 mm Hg at follow-up.
  • Symptomatic treatment-related lung toxicity occurred in 4 of 137 patients. Three had a temporary but marked increase in breathlessness on exertion. The fourth died of cardiac failure after developing lung infiltrates 3 months after radiotherapy ended.
  • One enrolled patient did not have follow-up testing because of steadily increasing pleural fibrosis from asbestos exposure.
• The authors' conclusion: The authors concluded that lung function changes 12 months after postoperative radiotherapy were minor in both the lobectomy and pneumonectomy groups. They suggested marginal lung reserve as one possible risk factor, defined using cutoffs of 1.2 L for FEV1 and 70 mm Hg for PaO2.
• Limitations the authors state:
  • The study did not define specific and consistent risk factors for radiation-related lung toxicity, although the authors suggested marginal lung reserve as one possible risk factor.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Carcinoma, Pulmonary Function Test (PFT), Pleural Thickening, Pneumonectomy, Squamous Cell Carcinoma, Adenocarcinoma, Hilum, Mediastinum.

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