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Correlation of six-minute walk test, pulmonary function test and radiation pneumonitis in the management of carcinoma of oesophagus: A prospective pilot study

Published online by Cambridge University Press:  16 November 2010

Sheh Rawat ,
Gaurav Kumar ,
Abhishek Puri ,
Manoj Kumar Sharma ,
Anjali Kakria  and
Pankaj Kumar
Sheh Rawat
Affiliation:
Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
Gaurav Kumar*
Affiliation:
Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
Abhishek Puri
Affiliation:
Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
Manoj Kumar Sharma
Affiliation:
Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
Anjali Kakria
Affiliation:
Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
Pankaj Kumar
Affiliation:
Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
*
Correspondence to: Gaurav Kumar, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, New Delhi, India. Tel: +91-11-47022222; Fax: +91-11-27051037; E-mail: [email protected]
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Abstract

Purpose: To correlate six-minute walk test (6MWT) and pulmonary function test (PFT) with incidence of radiation pneumonitis (RP) while treating patients with oesophageal cancer with conformal radiotherapy.

Methods: Forty-five patients were selected to the study protocol. Pulmonary evaluation was done objectively by chest x-ray (CXR), 6MWT and PFT and subjectively by symptoms of cough, dyspnoea and fatigue. These tests were performed before radiation and then repeated at 1, 3, 6 and 9 months after treatment. The dose-volume histogram (DVH) was used to derive doses received by lung and organs at risk. χ2-test was used for calculating the p value.

Results: The walk distance change (WDC) correlated with the changes in PFT values (p = 0.001) were done at 3 and 9 months after radiation, respectively. V30 values of ≥20% correlated with the incidence of acute pneumonitis (p = 0.007). 6MVT/vital capacity (VC) values of ≤4 ft/l had a correlation with the incidence of clinically symptomatic RP at 9 months.

Conclusion: 6MWT and PFT are supplementary to each other for assessing the lung function status; but their individual role in predicting RP is weak. However, they are complementary to each other in assessing the risk of radiation-induced lung dysfunction.

Keywords

Six-minute walk testpulmonary function testradiation pneumonitiscarcinoma of oesophagusdosimetric parameters
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 10 , Issue 3 , September 2011 , pp. 191 - 199
Copyright
Copyright © Cambridge University Press 2011

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References

Tucker, SL, Liu, HH, Wang, S, Wei, X, Liao, Z, Komaki, R, Cox, JD, Mohan, R. Dose-volume modeling of the risk of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys 2006; 66:754–761.CrossRefGoogle ScholarPubMed
Bosset, JF, Gignoux, M, Triboulet, JP, Tiret, E, Mantion, G, Elias, D, Lozach, P, Ollier, JC, Pavy, JJ, Mercier, M, Sahmoud, T. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 1997; 337:161–167.Google Scholar
Lee, HK, Vaporciyan, AA, Cox, JD, Tucker, SL, Putnam, JB Jr, Ajani, JA, Liao, Z, Swisher, SG, Roth, JA, Smythe, WR, Walsh, GL, Mohan, R, Liu, HH, Mooring, D, Komaki, R. Postoperative pulmonary complications after preoperative chemoradiation for esophageal carcinoma: correlation with pulmonary dose-volume histogram parameters. Int J Radiat Oncol Biol Phys 2003; 57:1317–1322.Google Scholar
Wang, SL, Liao, Z, Vaporciyan, AA, Tucker, SL, Liu, H, Wei, X, Swisher, S, Ajani, JA, Cox, JD, Komaki, R. Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys 2006; 64:692–699.Google Scholar
Minsky, BD, Pajak, TF, Ginsberg, RJ, Pisansky, TM, Martenson, J, Komaki, R, Okawara, G, Rosenthal, SA, Kelsen, DP. INT 0123 (Radiation Therapy Oncology Group 94–05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 2002; 20:1167–1174.CrossRefGoogle ScholarPubMed
Marks, LB, Munley, MT, Bentel, GC, Zhou, SM, Hollis, D, Scarfone, C, Sibley, GS, Kong, FM, Jirtle, R, Jaszczak, R, Coleman, RE, Tapson, V, Anscher, M. Physical and biological predictors of changes in whole-lung function following thoracic irradiation. Int J Radiat Oncol Biol Phys 1997; 39:563–570.CrossRefGoogle ScholarPubMed
Anscher, MS, Kong, FM, Marks, LB, Bentel, GC, Jirtle, RL. Changes in plasma transforming growth factor beta during radiotherapy and the risk of symptomatic radiation-induced pneumonitis. Int J Radiat Oncol Biol Phys 1997; 37:253–258.CrossRefGoogle ScholarPubMed
Anscher, MS, Kong, FM, Jirtle, RL. The relevance of transforming growth factor beta 1 in pulmonary injury after radiation therapy. Lung Cancer 1998; 19:109–120.CrossRefGoogle ScholarPubMed
Anscher, MS, Kong, FM, Andrews, K, Clough, R, Marks, LB, Bentel, G, Jirtle, RL. Plasma transforming growth factor beta1 as a predictor of radiation pneumonitis. Int J Radiat Oncol Biol Phys 1998; 41:1029–1035.CrossRefGoogle ScholarPubMed
Graham, MV, Purdy, JA, Emami, B, Harms, W, Bosch, W, Lockett, MA, Perez, CA. Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 1999; 45:323–329.CrossRefGoogle ScholarPubMed
Hernando, ML, Marks, LB, Bentel, GC, Zhou, SM, Hollis, D, Das, SK, Fan, M, Munley, MT, Shafman, TD, Anscher, MS, Lind, PA. Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer. Int J Radiat Oncol Biol Phys 2001; 51:650–659.Google Scholar
Fay, M, Tan, A, Fisher, R, Mac Manus, M, Wirth, A, Ball, D. Dose-volume histogram analysis as predictor of radiation pneumonitis in primary lung cancer patients treated with radiotherapy. Int J Radiat Oncol Biol Phys 2005; 61:1355–1363.Google Scholar
Kocak, Z, Yu, X, Zhou, SM, D’Amico, TA, Hollis, D, Kahn, D, Tisch, A, Shafman, TD, Marks, LB. The impact of pre-radiotherapy surgery on radiation-induced lung injury. Clin Oncol (R Coll Radiol) 2005; 17:210–216.Google Scholar
Kwa, SL, Lebesque, JV, Theuws, JC, Marks, LB, Munley, MT, Bentel, G, Oetzel, D, Spahn, U, Graham, MV, Drzymala, RE, Purdy, JA, Lichter, AS, Martel, MK, Ten Haken, RK. Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys 1998; 42:1–9.CrossRefGoogle ScholarPubMed
Schraube, P, Schell, R, Wannenmacher, M, Drings, P, Flentje, M. [Pneumonitis after radiotherapy of bronchial carcinoma: incidence and influencing factors]. Strahlenther Onkol 1997; 173:369–378.CrossRefGoogle ScholarPubMed
Miller, KL, Shafman, TD, Marks, LB. A practical approach to pulmonary risk assessment in the radiotherapy of lung cancer. Semin Radiat Oncol 2004; 14:298–307.CrossRefGoogle ScholarPubMed
Holland, AE, Hill, CJ, Conron, M, Munro, P, McDonald, CF. Small changes in six-minute walk distance are important in diffuse parenchymal lung disease. Respir Med 2009; 103:1430–1435.CrossRefGoogle ScholarPubMed
Flaherty, KR, Andrei, AC, Murray, S, Fraley, C, Colby, TV, Travis, WD, Lama, V, Kazerooni, EA, Gross, BH, Toews, GB, Martinez, FJ. Idiopathic pulmonary fibrosis: prognostic value of changes in physiology and six-minute-walk test. Am J Respir Crit Care Med 2006; 174:803–809.CrossRefGoogle ScholarPubMed
Chetta, A, Aiello, M, Foresi, A, Marangio, E, D’Ippolito, R, Castagnaro, A, Olivieri, D. Relationship between outcome measures of six-minute walk test and baseline lung function in patients with interstitial lung disease. Sarcoidosis Vasc Diffuse Lung Dis 2001; 18:170–175.Google ScholarPubMed
Baughman, RP, Sparkman, BK, Lower, EE. Six-minute walk test and health status assessment in sarcoidosis. Chest 2007; 132:207–213.CrossRefGoogle ScholarPubMed
Redelmeier, DA, Bayoumi, AM, Goldstein, RS, Guyatt, GH. Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med 1997; 155:1278–1282.Google Scholar
Puhan, MA, Mador, MJ, Held, U, Goldstein, R, Guyatt, GH, Schünemann, HJ. Interpretation of treatment changes in 6-minute walk distance in patients with COPD. Eur Respir J 2008; 32:637–643.CrossRefGoogle ScholarPubMed
American Thoracic Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement. American Thoracic Society (ATS), and the European Respiratory Society (ERS). Am J Respir Crit Care Med 2000; 161: 646–664.CrossRefGoogle Scholar
Tucker, SL, Liu, HH, Wang, S, Wei, X, Liao, Z, Komaki, R, Cox, JD, Mohan, R. Dose-volume modeling of the risk of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys 2006; 66:754–761.CrossRefGoogle ScholarPubMed
Kutcher, GJ, Burman, C. Calculation of complication probability factors for non-uniform normal tissue irradiation: the effective volume method. Int J Radiat Oncol Biol Phys 1989; 16:1623–1630.CrossRefGoogle ScholarPubMed
Lyman, JT. Complication probability as assessed from dose-volume histograms. Radiat Res Suppl 1985; 8:S13–S19.CrossRefGoogle ScholarPubMed
ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166:111–117.CrossRefGoogle Scholar
Common Terminology Criteria For Adverse Events Version 3 (CTCAE v6). Published in August 2006.Google Scholar
Miller, KL, Kocak, Z, Kahn, D, Zhou, SM, Baydush, A, Hollis, D, Folz, RJ, Tisch, A, Clough, R, Yu, X, Light, K, Marks, LB. Preliminary report of the 6-minute walk test as a predictor of radiation-induced pulmonary toxicity. Int J Radiat Oncol Biol Phys 2005; 62:1009–1013.Google Scholar
Tsujino, K, Hirota, S, Endo, M, Obayashi, K, Kotani, Y, Satouchi, M, Kado, T, Takada, Y. Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys 2003; 55:110–115.Google Scholar
Nutting, CM, Bedford, JL, Cosgrove, VP, Tait, DM, Dearnaley, DP, Webb, S. A comparison of conformal and intensity-modulated techniques for oesophageal radiotherapy. Radiother Oncol 2001; 61:157–163.CrossRefGoogle ScholarPubMed
Söderström, S, Brahme, A. Which is the most suitable number of photon beam portals in coplanar radiation therapy?. Int J Radiat Oncol Biol Phys 1995; 33:151–159.CrossRefGoogle ScholarPubMed
Stein, J, Mohan, R, Wang, XH, Bortfeld, T, Wu, Q, Preiser, K, Ling, CC, Schlegel, W. Number and orientations of beams in intensity-modulated radiation treatments. Med Phys 1997; 24:149–160.Google Scholar
Hulscher, JB, van Sandick, JW, de Boer, AG, Wijnhoven, BP, Tijssen, JG, Fockens, P, Stalmeier, PF, ten Kate, FJ, van Dekken, H, Obertop, H, Tilanus, HW, van Lanschot, JJ. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002; 347:1662–1669.CrossRefGoogle ScholarPubMed
Mao, J, Zhang, J, Zhou, S, Das, S, Hollis, DR, Folz, RJ, Wong, TZ, Marks, LB. Updated assessment of the six-minute walk test as predictor of acute radiation-induced pneumonitis. Int J Radiat Oncol Biol Phys 2007; 67:759–767.Google Scholar