Predicting risk of radiation-induced lung injury

Madani, Indira; De Ruyck, Kim; Goeminne, Hannelore; De Neve, Wilfried; Thierens, Hubert; van Meerbeeck, Jan

doi:10.1097/JTO.0B013E318145B2C6

Title

Predicting risk of radiation-induced lung injury

Author

Madani, Indira

De Ruyck, Kim

Goeminne, Hannelore

De Neve, Wilfried

Thierens, Hubert

van Meerbeeck, Jan

Abstract

Radiation-induced lung injury (RILI) is the most common, dose-limiting complication of thoracic radio- and radiochemotherapy. Unfortunately, predicting which patients will suffer from this complication is extremely difficult. Ideally, individual phenotype- and genotype-based risk profiles should be able to identify patients who are resistant to RILI and who could benefit from dose escalation in chemoradiotherapy. This could result in better local control and overall survival. We review the risk predictors that are currently in clinical use-dosimetric parameters of radiotherapy such as normal tissue complication probability, mean lung dose, V20 and V30-as well as biomarkers that might individualize risk profiles. These biomarkers comprise a variety of proinflammatory and profibrotic cytokines and molecules including transforming growth factor beta 1 that are implicated in development and persistence of RILI. Dosimetric parameters of radiotherapy show a low negative predictive value of 60% to 80%. Depending on the studied molecule, negative predictive value of biomarkers is approximately 50%. The predictive power of biomarkers might be increased if they are coupled with radiogenomics, e.g., genotyping analysis of single nucleotide polymorphisms in transforming growth factor beta 1, transforming growth factor beta 1 pathway genes, and other cytokines. Genetic variability and the complexity of RILI and its underlying molecular mechanisms make identification of biological risk predictors challenging. Further investigations are needed to develop more effective risk predictors of RILI.

Language

English

Source (journal)

Journal of thoracic oncology / International Association for the Study of Lung Cancer [Aurora, Colo.] - Hagerstown, Md, 2006, currens

Publication

Hagerstown, Md : Lippincott Williams & Wilkins , 2007

ISSN

1556-0864 [print]

1556-1380 [online]

DOI

10.1097/JTO.0B013E318145B2C6

Volume/pages