4DCT-based evaluation of lung tumour motion during the breathing cycle.

The aim of this work was to quantify the variability in pre-treatment lung tumor motion during a single breathing period for 55 non-small cell lung cancer (NSCLC) targets. The influence of breathing on the volume and position of lung tumor was examined by comparing the information about tumor from respiratory-correlated four-dimensional computed tomography (4DCT) and three-dimensional computed tomography (3DCT) obtained without respiratory monitoring. The impact of age, gender, lung volume changes and immobilization device on tumor respiratory motion was evaluated. Based on the performed analysis, the significant differences were found between tumor volumes on 3DCT and 4DCT, although the comparison of volumes between 4DCT bins showed no statistically significant dependency. The significant differences between tumor centre of mass coordinates in the cranial-caudal (CC) and anterior-posterior (AP) directions were found. According to the results of statistical testing, there was no impact of gender and immobilization device on detected tumor respiratory motion. The impact was found for patient's age, lung volume changes, tumor volume and its location in different lung segments. The dominant lung cancer motion was observed for smaller tumors (up to 20 cc) located in posterior, caudal segments. This effect was also associated with a large variation in the lung volume during one respiratory cycle, observed for older patients. The important finding of the study is connected with the description of different patterns of tumor motion in AP and CC directions.

Prediction of radiation pneumonitis: dose-volume histogram analysis in 62 patients with non-small cell lung cancer after three-dimensional conformal radiotherapy.

The purpose of the study was to determine the relation between the incidence of radiation pneumonitis (RP) and available parameters from a dose-volume histogram (DVH) in patients with non-small cell lung cancer (NSCLC) who underwent three-dimensional conformal radiotherapy treatment. Between January 1999 and August 2003 in the Greatpoland Cancer Center, 62 patients with NSCLC were treated using three-dimensional conformal radiotherapy (3D CRT). All patients were treated 5 days per week with daily fractionation of 2 Gy to total dose of 60 Gy. All patients were available for analysis for symptomatic RP. Radiation pneumonitis was graded according to the RTOG/EORTC morbidity scoring classification. Logistic regression analysis was performed to test the association between RP and the following DVH parameters: mean lung dose (MLD), volume of lung receiving > or =20 Gy (V20 ) and > or =30 Gy (V30) and normal tissue complication probability (NTCP). Additionally, correlation of the following clinical factors such as: age, sex, tumor site, performance status (KPS), and additional therapy (chemotherapy) with incidence of the RP were performed. Moreover, correlation between DVH parameters were tested using Spearman method. Thirty out of 62 patients (48%) developed RP grade 0 or 1 (0 grade -- 12%, 1 grade -- 36%) and 32 (52%) grade 2 or 3 (2 grade -- 47%, 3 grade -- 5%). In the logistic regression analysis, all DVH parameters were associated with RP (p in range from 0.004 to 0.007). The strongest association was observed for NTCP and V30 (p=0.004). On the other hand, a weak association was found for V20 (p=0.007). The correlations between all DVH parameters for lung were sufficient (r Spearman in range from 0.87 to 0.93). The best correlation among DVH parameters were observed between V20 and NTCP (r=0.93, p<0.001). On the other hand, the least but sufficient association was found for V30 and V20 (r=0.87, p<0.001). There was no association between clinical factors and RP. NTCP and V30 parameters were the best predictors of symptomatic radiation pneumonitis for patients after three-dimensional conformal radiotherapy of non-small cell lung cancer.

A prospective, randomised study to compare two palliative radiotherapy schedules for non-small-cell lung cancer (NSCLC).

A prospective randomised study compared two palliative radiotherapy schedules for inoperable symptomatic non-small-cell lung cancer (NSCLC). After stratification, 100 patients were randomly assigned to 20 Gy/5 fractions (fr)/5 days (arm A) or 16 Gy/2 fr/day 1 and 8 (arm B). There were 90 men and 10 women aged 47-81 years (mean 66), performance status 1-4 (median 2). The major clinical characteristics and incidence and degree of initial disease-related symptoms were similar in both groups. Treatment effects were assessed using patient's chart, doctor's scoring of symptomatic change and chest X-ray. Study end points included degree and duration of symptomatic relief, treatment side effects, objective response rates and overall survival. A total of 55 patients were assigned to arm A and 45 to arm B. In all, 98 patients received assigned treatment, whereas two patients died before its termination. Treatment tolerance was good and did not differ between study arms. No significant differences between study arms were observed in the degree of relief of all analysed symptoms. Overall survival time differed significantly in favour of arm B (median 8.0 vs 5.3 months; P=0.016). Both irradiation schedules provided comparable, effective palliation of tumour-related symptoms. The improved overall survival and treatment convenience of 2-fraction schedule suggest its usefulness in the routine management of symptomatic inoperable NSCLC.

Serum levels of interleukin-10 and interleukin-6 in patients with lung cancer.

Since the enhanced production of IL-10 by human bronchogenic carcinoma has already been documented, in the present study serum levels of IL-10 were measured serially in patients with lung cancer undergoing radiotherapy. Thirty-one full diagnosed cancer patients underwent the radiotherapy procedures. The interleukin-10 (IL-10) and interleukin-6 (IL-6) serum levels were measured before therapy and after 3, 6 and 12 months after therapy. The interleukins concentrations were evaluated using a solid phase sandwich Enzyme-Linked-Immuno-Sorbent-Assay (ELISA). In all patients the serum levels of IL-10 have been found elevated. Due to the treatment they progressively declined to almost normal ranges in responders, while they remained elevated in non-responders. Serum levels of interleukin-6 have been elevated in the majority of our patients. After 12 months observation they also decreased, mainly in patients responding to the treatment. No correlation between serum IL-10 and IL-6 level has been found. The importance of serum IL-6 determination in lung cancer patients monitoring has already been established. The present study shows, that in spite of still unclear role of IL-10 in the process of carcinogenesis, it may be considered as a prognostic factor in lung cancer.