Predicting Risk of Radiation-Induced Lung Injury

Indira Madani, Kim De Ruyck, Hannelore Goeminne, Wilfried De Neve, Hubert Thierens, Jan Van Meerbeeck
2007 Journal of Thoracic Oncology  
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
more » ... e 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 ␤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 ␤1, transforming growth factor ␤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.
doi:10.1097/jto.0b013e318145b2c6 pmid:17805067 fatcat:trtj5faqnrfg5giojf3guaudle