• Zeinab Abou Yehia, George N Mikhaeel, Grace Smith, Chelsea C Pinnix, Sarah A Milgrom, Chad Tang, Wen Jiang, Michelle A Fanale, Yasuhiro Oki, JoAnn H Shank, Trisha Horace, Jay Reddy, Mani Akhtari, Jillian R Gunther, Tina Suki, Pamela K Allen, Shryll Turner, Osama Mawlawi, and Bouthaina S Dabaja.
• Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
• Int. J. Radiat. Oncol. Biol. Phys. 2016 Dec 1; 96 (5): 951-958.

PurposeBleomycin pulmonary toxicity (BPT) is a well-known complication of treatment in patients with Hodgkin lymphoma (HL). We undertook the present study to investigate the risk of radiation pneumonitis (RP) in the setting of BPT and to determine the need for delay or omission of radiation therapy (RT) in these patients.Methods And MaterialsWe identified 123 HL patients treated with ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine) followed by RT to the chest from January 2009 to December 2014. The medical records were reviewed for clinical, pathologic, and treatment information and toxicities. Our primary outcome was RP of any grade. Univariate and multivariate analyses were used to assess the association of BPT, baseline patient characteristics, and treatment variables with the incidence of RP.ResultsA total of 123 patients were included, of whom 99 (80%) received consolidation intensity modulated RT after ABVD treatment. We identified 31 patients (25.2%) with BPT after frontline ABVD. Seventeen patients (13.8%) developed RP a median of 8 weeks (range 1-39) after RT completion. BPT did not correlate with the risk of developing RP (P=.36). We evaluated the RP outcomes with respect to the bleomycin to RT interval (≤6 weeks vs >6 weeks), and we found that this interval did not predict for RP risk (P=.60). Dosimetric parameters such as the volume covered by 5 Gy and the mean lung dose were analyzed. A volume covered by 5 Gy of >55% and mean lung dose >13.5 Gy increased the risk of RP by 1.14-fold (P=.002) and 4.24-fold (P=.007), respectively.ConclusionsThe results of our study suggest that BPT does not increase the risk of developing RP. Furthermore, RT initiation does not need to be delayed after chemotherapy, except to allow for the completion of steroid therapy or clinical recovery from BPT.Copyright © 2016 Elsevier Inc. All rights reserved.

47 keywords...

hide…