Correlation Between Tyrosine Kinase Inhibitor Therapy And Radiotherapy Induced Radiation Pneumonitis In Patients With Advanced Non-small Cell Lung Cancer

Purpose:This retrospective study was designed to investigate the extent of computed tomography(CT)image findings and the incidence of?3 Grade radiation pneumonitis in patients with advanced non-small cell lung cancer who have concurrent or sequential oral tyrosine kinase inhibitors during thoracic radiotherapy.Materials and Methods:We reviewed the medical records and computed tomography(CT)images of ?b/? non-small cell lung cancer(NSCLC)patients who underwent thoracic radiotherapy in Peking Union Medical College Hospital from January 2013 to December 2017 and had oral tyrosine kinase inhibitor(TKI)for more than 3 months.The patients were divided into two groups:"radiation therapy and synchronized targeted therapy group" and "radiation therapy and sequential targeted therapy group"according to whether there was targeted drug used during radiotherapy.The incidence of patients with grade 3 radiation pneumonitis(CTCAE v.4.0),and the extent of radiological findings of CT were measured and estimated.logistic regression analysis was used to assess the effect of TKI use synchronized during thoracic radiotherapy on the risk of developing grade 3 radiation pneumonitis as well as the extent of radiological findings.Results:A total of 103 patients were included in the analysis.The median age was 60.5 years,males were 50.5%,non-squamous cancers were 87.4%,and the proportions of stage ? and ? were 24.3%and 75.7%,respectively.Patients received 10-72Gy/3-24 fractions of thoracic radiotherapy.Eleven cases(10.7%)had?3 grade radiation pneumonitis,and 2 patients with radiation pneumonitis died due to complication of infection.There were 7 cases of?grade 3 radiation pneumonitis(17.1%)in the radiotherapy and synchronized TKI group,and 4 cases(6.5%)in the of radiotherapy and sequential TKI group.Logistic regression adjusted for age,gender,and ECOG scores.Synchronized TKI during radiotherapy was associated with an increased risk of CTCAE?3 RP compared to patients without TKI during radiotherapy(OR=4.40,95%CI:1.05-18.47,P=0.04),while the synchronized group of radiotherapy and TKI increased the risk of larger extent of imaging changes(OR=7.32,95%CI:2.10-25.43,P=0.002)).There was no significant difference in the risk of?3 grade RP in patients who received radiotherapy to eliminate oligoprogression or as consolidation radiation before progression.(P=0.58,OR=2.32,95%CI:0.35-15.43).Conclusion:In advanced non-small cell lung cancer,the use of synchronized TKI during thoracic radiotherapy is generally tolerable.The concurrent TKI during radiotherapy increases the risk of larger extent of CT images involvement and increases the risk of developing?grade 3 radiation pneumonitis.