Pulmonary damage in Hodgkin's lymphoma patients treated with sequential chemo-radiotherapy: Predictors of radiation-induced lung injury

Figures & data

Table I. Patient, disease and treatment characteristics.

	Median	Range
Age (y)	26	(14–55)
Left lung volume (cm^3)	1247	(664–2793)
Right lung volume (cm^3)	1465	(732–2989)
	n	%
Gender
Female	39	56
Male	30	44
Histology
Nodular sclerosis	49	72
Mixed cellularity	17	25
Lymphocyte-rich-classical	2	3
Stage
I–II	54	78
III–IV	15	22
Chemotherapy regimen
ABVD	15	22
VEBEP	54	78
Chemotherapy cycles
4	11	16
6	58	84
Radiotherapy dose delivered (Gy)
28.5–30.0	28	41
30.1–32.0	29	43
32.1–36.0	8	12
36.1–45.0	3	4
Comorbidity and lifestyle factors*
None	53	77
Yes	16	23
Smoke	10	15
Diabetes	1	1
Hypertension	2	3
Hypercholesterolemia	0	0
Cardiac comorbities	5	7
Elevated CRP	48	70
Elevated LDH	19	27

ABVD, doxorubicin, bleomycin, vinblastine and dacarbazine; CRP, C-reactive protein; LDH, lactate dehydrogenase; VEBEP, vinblastine, etoposide, bleomycin, epidoxorubicin.

*There can be multiple factors simultaneously.

Table II. Results of the multivariate analyses for symptomatic radiation-induced lung injury (RILI) and CT changes.

Endpoint	Parameter	Estimated coefficient	SE	p-value	OR	95% CI
Symptomatic RILI	Left-lung V30 (%)	0.151	0.061	0.014	1.164	1.031–1.312
	constant	−7.312	2.386	0.002
CT changes	Total-lung V30 (%)	0.136	0.052	0.009	1.146	1.035–1.270
	constant	−4.8528	1.380	0.001
CT changes	Left-lung V30 (%)	0.103	0.036	0.004	1.108	1.033–1.189
	constant	−4.257	1.069	0.001

Figure 1. Receiver operating characteristic curve and histogram of outcome distribution for discrimination value definition: (a) LL-V30 for symptomatic RILI; (b) TL-V30 for radiological CT changes; (c) LL-V30 for radiological CT changes. The dotted line represents the discrimination value.

Figure 2. Comparison of risk curves obtained by logistic regression model with the fraction of complications from the data grouped in quartiles for: (a) LL-V30 for symptomatic RILI (4 events over 69 patients), (b)–(c) TL-V30 and LL-V30 for radiological CT changes (nine events over 69 patients). The error bars are the standard deviation calculated from the data.