Patients with non-small cell lung cancer (NSCLC) and interstitial lung disease (ILD) are often excluded from clinical trials because they are considered to be at high risk for acute exacerbation (AE) of ILD triggered by radiotherapy. Therefore, data on the clinical course in these patients are limited. We examined the relationship between chemoradiotherapy (CRT) and occurrence of AE of ILD as well as the clinical course in these patients at our institution.
A retrospective analysis was performed on 37 patients with stage III NSCLC and ILD treated with first-line CRT in a clinical setting between January 2009 and December 2014 at our institution.
Patient characteristics are shown in Table 1. Patients treated with CRT had milder ILD than those treated with chemotherapy alone. Eighteen patients treated with CRT received corticosteroids for the treatment of AE of ILD. Univariate analysis revealed that the risk factors for AE of ILD were ILD classification, smoking history, and V20. In multivariate logistic regression analysis, the independent risk factor for AE of ILD was ILD classification. AE of ILD occurred in nine (82%) patients with usual interstitial pneumonia (UIP) pattern and in nine (35%) with non-UIP pattern. Median overall survival (mOS) was 34.6 months. Univariate analysis and multivariate logistic regression analysis revealed that the prognostic factor for patients with stage III NSCLC and ILD treated with CRT was ILD classification. mOS was 10.9 and 43.0 months in UIP and non-UIP patterns, respectively.rnTable:
|First-line treatment Variable||Chemoradiotherapy||Radiotherapy||Chemotherapyrn|
|(N = 37)||(N = 17)||(N = 25)rn|
|Age, median (range)rn||73 (52–85)rn||80 (59–89)rn||69 (58–81)rn|
|Clinical staging (TNM classification, 7th edition), IIIA/IIIBrn||20/17rn||8/9rn||10/15rn|
|Smoking history, yes/norn||33/4rn||16/1rn||24/1rn|
|ILD classification, UIP/non-UIPrn||11/26rn||6/11rn||16/9rn|
|%VC, median (range)rn||96 (59–129)rn||86 (62–112)rn||85 (64–121)rn|
|V20, median (range)rn||27 (12–35)rn||26 (14–36)rn||rn|
|Lung volume loss or honeycombingrn||4rn||4rn||13rn|
In conclusion, this retrospective analysis suggests that ILD classification (UIP or non-UIP) is associated with the occurrence of AE of ILD and prognosis in patients treated with first-line CRT.
Clinical trial identification
The study protocol was approved by the Institutional Review board of Shizuoka Cancer Center (28-J167-28-1-3).
Legal entity responsible for the study
All authors have declared no conflicts of interest.