Cargando…

Clinical Management and Outcome of Grade III Pneumonitis after Chemoradioimmunotherapy for Inoperable Stage III Non-Small Cell Lung Cancer—A Prospective Longitudinal Assessment

Background: Maintenance treatment with immune-checkpoint inhibition (ICI) has been shown to significantly improve patient prognosis after chemoradiotherapy (CRT) for inoperable stage III NSCLC. This survival advantage may be achieved at the expense of an increased probability for symptomatic pneumon...

Descripción completa

Detalles Bibliográficos
Autores principales: Kauffmann-Guerrero, Diego, Taugner, Julian, Eze, Chukwuka, Käsmann, Lukas, Li, Minglun, Tufman, Amanda, Manapov, Farkhad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8619082/
https://www.ncbi.nlm.nih.gov/pubmed/34829315
http://dx.doi.org/10.3390/diagnostics11111968
_version_ 1784604903753121792
author Kauffmann-Guerrero, Diego
Taugner, Julian
Eze, Chukwuka
Käsmann, Lukas
Li, Minglun
Tufman, Amanda
Manapov, Farkhad
author_facet Kauffmann-Guerrero, Diego
Taugner, Julian
Eze, Chukwuka
Käsmann, Lukas
Li, Minglun
Tufman, Amanda
Manapov, Farkhad
author_sort Kauffmann-Guerrero, Diego
collection PubMed
description Background: Maintenance treatment with immune-checkpoint inhibition (ICI) has been shown to significantly improve patient prognosis after chemoradiotherapy (CRT) for inoperable stage III NSCLC. This survival advantage may be achieved at the expense of an increased probability for symptomatic pneumonitis as CRT as well as ICI treatment is associated with the risk of treatment-related pulmonary toxicity. Methods: We screened a prospective chemoradioimmunotherapy (CRT-IO) cohort consisting of 38 patients and identified patients with therapy-related grade 3 pneumonitis. All patients were treated with intravenous high dose corticosteroids and closely monitored by CT-scans and extended longitudinal lung function tests. We analyzed lung function parameters and CT morphological features to characterize patients’ outcome. Results: Six (16%) patients treated with CRT-IO developed grade 3 pneumonitis one to six months after completion CRT. In the CT imaging, pneumonitis was characterized by diffuse ground glass capacities and in part pulmonary consolidations within and outside the planning target volume. Onset of pneumonitis was accompanied by a reduction in diffusion capacity in all cases. The mean decline of diffusion capacity was 25.8% [6–53%]. Under treatment with corticosteroids, all patients recovered regarding symptoms and changes in CT morphology. In five out of six patients, diffusion capacity improved to at least 80% of the baseline [80–96%]. One patient showed a significant increase of diffusion capacity after treatment (from 32% to 53%) but reached only 62% of the initial value. Conclusions: Pneumonitis is a severe complication of CRT-IO. High-resolution CT imaging and extended lung function testing proved to be a suitable approach in detecting and monitoring of CRT-IO associated pneumonitis.
format Online
Article
Text
id pubmed-8619082
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-86190822021-11-27 Clinical Management and Outcome of Grade III Pneumonitis after Chemoradioimmunotherapy for Inoperable Stage III Non-Small Cell Lung Cancer—A Prospective Longitudinal Assessment Kauffmann-Guerrero, Diego Taugner, Julian Eze, Chukwuka Käsmann, Lukas Li, Minglun Tufman, Amanda Manapov, Farkhad Diagnostics (Basel) Communication Background: Maintenance treatment with immune-checkpoint inhibition (ICI) has been shown to significantly improve patient prognosis after chemoradiotherapy (CRT) for inoperable stage III NSCLC. This survival advantage may be achieved at the expense of an increased probability for symptomatic pneumonitis as CRT as well as ICI treatment is associated with the risk of treatment-related pulmonary toxicity. Methods: We screened a prospective chemoradioimmunotherapy (CRT-IO) cohort consisting of 38 patients and identified patients with therapy-related grade 3 pneumonitis. All patients were treated with intravenous high dose corticosteroids and closely monitored by CT-scans and extended longitudinal lung function tests. We analyzed lung function parameters and CT morphological features to characterize patients’ outcome. Results: Six (16%) patients treated with CRT-IO developed grade 3 pneumonitis one to six months after completion CRT. In the CT imaging, pneumonitis was characterized by diffuse ground glass capacities and in part pulmonary consolidations within and outside the planning target volume. Onset of pneumonitis was accompanied by a reduction in diffusion capacity in all cases. The mean decline of diffusion capacity was 25.8% [6–53%]. Under treatment with corticosteroids, all patients recovered regarding symptoms and changes in CT morphology. In five out of six patients, diffusion capacity improved to at least 80% of the baseline [80–96%]. One patient showed a significant increase of diffusion capacity after treatment (from 32% to 53%) but reached only 62% of the initial value. Conclusions: Pneumonitis is a severe complication of CRT-IO. High-resolution CT imaging and extended lung function testing proved to be a suitable approach in detecting and monitoring of CRT-IO associated pneumonitis. MDPI 2021-10-23 /pmc/articles/PMC8619082/ /pubmed/34829315 http://dx.doi.org/10.3390/diagnostics11111968 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Communication
Kauffmann-Guerrero, Diego
Taugner, Julian
Eze, Chukwuka
Käsmann, Lukas
Li, Minglun
Tufman, Amanda
Manapov, Farkhad
Clinical Management and Outcome of Grade III Pneumonitis after Chemoradioimmunotherapy for Inoperable Stage III Non-Small Cell Lung Cancer—A Prospective Longitudinal Assessment
title Clinical Management and Outcome of Grade III Pneumonitis after Chemoradioimmunotherapy for Inoperable Stage III Non-Small Cell Lung Cancer—A Prospective Longitudinal Assessment
title_full Clinical Management and Outcome of Grade III Pneumonitis after Chemoradioimmunotherapy for Inoperable Stage III Non-Small Cell Lung Cancer—A Prospective Longitudinal Assessment
title_fullStr Clinical Management and Outcome of Grade III Pneumonitis after Chemoradioimmunotherapy for Inoperable Stage III Non-Small Cell Lung Cancer—A Prospective Longitudinal Assessment
title_full_unstemmed Clinical Management and Outcome of Grade III Pneumonitis after Chemoradioimmunotherapy for Inoperable Stage III Non-Small Cell Lung Cancer—A Prospective Longitudinal Assessment
title_short Clinical Management and Outcome of Grade III Pneumonitis after Chemoradioimmunotherapy for Inoperable Stage III Non-Small Cell Lung Cancer—A Prospective Longitudinal Assessment
title_sort clinical management and outcome of grade iii pneumonitis after chemoradioimmunotherapy for inoperable stage iii non-small cell lung cancer—a prospective longitudinal assessment
topic Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8619082/
https://www.ncbi.nlm.nih.gov/pubmed/34829315
http://dx.doi.org/10.3390/diagnostics11111968
work_keys_str_mv AT kauffmannguerrerodiego clinicalmanagementandoutcomeofgradeiiipneumonitisafterchemoradioimmunotherapyforinoperablestageiiinonsmallcelllungcanceraprospectivelongitudinalassessment
AT taugnerjulian clinicalmanagementandoutcomeofgradeiiipneumonitisafterchemoradioimmunotherapyforinoperablestageiiinonsmallcelllungcanceraprospectivelongitudinalassessment
AT ezechukwuka clinicalmanagementandoutcomeofgradeiiipneumonitisafterchemoradioimmunotherapyforinoperablestageiiinonsmallcelllungcanceraprospectivelongitudinalassessment
AT kasmannlukas clinicalmanagementandoutcomeofgradeiiipneumonitisafterchemoradioimmunotherapyforinoperablestageiiinonsmallcelllungcanceraprospectivelongitudinalassessment
AT liminglun clinicalmanagementandoutcomeofgradeiiipneumonitisafterchemoradioimmunotherapyforinoperablestageiiinonsmallcelllungcanceraprospectivelongitudinalassessment
AT tufmanamanda clinicalmanagementandoutcomeofgradeiiipneumonitisafterchemoradioimmunotherapyforinoperablestageiiinonsmallcelllungcanceraprospectivelongitudinalassessment
AT manapovfarkhad clinicalmanagementandoutcomeofgradeiiipneumonitisafterchemoradioimmunotherapyforinoperablestageiiinonsmallcelllungcanceraprospectivelongitudinalassessment