Can exhaled NO fraction predict radiotherapy-induced lung toxicity in lung cancer patients?
1 Pôle de Pathologie Thoracique, Hôpitaux Universitaires, BP 426, 67091, Strasbourg Cedex, France
2 Département Universitaire de Radiothérapie, Centre de lutte contre le cancer Paul Strauss, 3, rue de la Porte de l’Hôpital, BP 42, 67065, Strasbourg, France
3 Service de Radiologie B, Hôpitaux Universitaires, BP 426, 67091, Strasbourg Cedex, France
4 Laboratoire de Biostatistique, Université de Strasbourg, Faculté de Médecine, 4, rue Kirschleger, 67085, Strasbourg, France
5 Service de Physiologie et d’Explorations Fonctionnelles, Pôle de Pathologie Thoracique, Hôpitaux Universitaires, BP 426, 67091, Strasbourg Cedex, France
Radiation Oncology 2012, 7:117 doi:10.1186/1748-717X-7-117Published: 28 July 2012
A large increase in nitric oxide fraction (FeNO) after radiotherapy (RT) for lung cancer may predict RT-induced lung toxicity.
In this study, we assessed the relationships between FeNO variations and respiratory symptoms, CT scan changes or dose volume histogram (DVH) parameters after RT. We measured FeNO before RT, 4, 5, 6, 10 weeks, 4 and 7.5 months after RT in 65 lung cancer patients.
Eleven lung cancer patients (17%) complained of significant respiratory symptoms and 21 (31%) had radiation pneumonitis images in >1/3 of the irradiated lung after RT. Thirteen patients (20%) showed increases in FeNO >10 ppb. The sensitivity and specificity of a >10 ppb FeNO increase for the diagnosis of RT-associated respiratory symptoms were 18% and 83%, respectively. There was no correlation between DVH parameters or CT scan changes after RT and FeNO variations. Three patients (5%) showed intriguingly strong (2 or 3-fold, up to 55 ppb) and sustained increases in FeNO at 4 and 5 weeks, followed by significant respiratory symptoms and/or radiation-pneumonitis images.
Serial FeNO measurements during RT had a low ability to identify lung cancer patients who developed symptoms or images of radiation pneumonitis. However, three patients presented with a particular pattern which deserves to be investigated.