Prediction of radiation pneumonitis in lung cancer patients: a systematic review

Purpose Factors prediction in the development of radiation pneumonitis (RP) remains unclear. A meta-analysis about this was performed. Materials Articles were searched in February 2012 from PubMed, EMBASE, Cochrane Library and CNKI (Chinese Journal Full-text Database) using the keywords "lung cancer," "radiation pneumonitis" or "radiation lung injury." The outcome was the RP incidence. We pooled the data using RevMan 5.1 software and tested the statistical heterogeneity. Results We included the following factors: age, gender, weight loss, smoking history, complications, performance status, pre-radiation therapy (RT) pulmonary function, TNM, histological type, tumor location, pre-RT surgery, RT combined with chemotherapy (RCT), RT/RCT combined with amifostine, plasma end/pre-RT TGF-beta 1 ratio and irradiation volume. The significant risk factors for RP >= grade 2 were patients with chronic lung disease, tumor located in the middle or lower lobe, without pre-RT surgery, RCT, plasma end/pre-RT TGF-beta 1 ratio >= 1 and gross tumor volume (GTV). Following factors were identified significant for RP, including tumor located not in the upper lobe, smokers, combined with chronic lung diseases or diabetes mellitus, low pre-RT pulmonary function, RCT, RT/RCT without amifostine and plasma end/pre-RT TGF-beta 1 ratio >= 1. Dose-volume parameters included the average of mean lung dose (MLD) of disease lung, GTV and V (5), V (10) (>= 34 %), V (20) (>= 25 %), V (30) (>= 18 %) of bilateral lung. Conclusions More attention should be paid to the levels of patients' pulmonary function, plasma TGF-beta 1 and dose-volume histogram (DVH). Rigorous studies are needed to identify the relationship between the above-mentioned factors and RP >= grade 1 or 3.