Acute and Late Toxicities of Concurrent Chemoradiotherapy for Locally-Advanced Non-Small Cell Lung Cancer
Abstract
:1. Introduction
2. Acute Toxicities
2.1. Esophagitis
2.2. Radiation Pneumonitis
2.3. Hematologic Toxicities
3. Late Toxicities
3.1. Cardiotoxicity
3.2. Pulmonary Fibrosis
4. Strategies to Reduce Toxicities
5. Conclusions and Future Directions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Scale | Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 |
---|---|---|---|---|---|
RTOG | Mild dysphagia or odynophagia; may require topical anesthetic, non-narcotic agents, or soft diet | Moderate dysphagia or odynophagia; may require narcotics agents or puree/liquid diet | Severe dysphagia or odynophagia with dehydration or weight loss (>15% from pretreatment baseline) requiring nasogastric feeding tube, IV fluids, or hyperalimentation | Complete obstruction, ulceration, perforation or fistula | Death from esophagitis or complications |
CTCAE | Asymptomatic; clinical or diagnostic observations only; intervention not indicated | Symptomatic; altered eating/swallowing; oral supplements indicated | Severely altered eating/swallowing; tube feeding, TPN or hospitalization indicated | Life-threatening consequences; urgent operative intervention indicated | Death |
Scale | Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 |
---|---|---|---|---|---|
RTOG | Mild symptoms of dry cough or dyspnea on exertion | Persistent cough requiring narcotic, antitussive agents/dyspnea with minimal effort but not at rest | Severe cough unresponsive to narcotic antitussive agent or dyspnea at rest/clinical or radiological evidence of acute pneumonitis/intermittent oxygen or steroids may be required | Severe respiratory insufficiency/continuous oxygen or assisted ventilation | Death |
CTCAE | Asymptomatic; clinical or diagnostic observations only; intervention not indicated | Symptomatic; medical intervention indicated; limiting instrumental ADL | Severe symptoms; limiting self-care ADL; oxygen indicated | Life-threatening respiratory compromise; urgent intervention indicated (e.g., tracheotomy or intubation) | Death |
Scale | Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 |
---|---|---|---|---|---|
RTOG | Asymptomatic or mild symptoms (dry cough); slight radiographic appearances | Moderate symptomatic fibrosis or pneumonitis (severe cough); low grade fever; patchy radiographic appearances | Severe symptomatic fibrosis or pneumonitis; dense radiographic changes | Severe respiratory insufficiency/continuous oxygen/assisted ventilation | Death |
CTCAE | Mild hypoxemia; radiologic pulmonary fibrosis | Moderate hypoxemia; evidence of pulmonary hypertension; radiographic pulmonary fibrosis 25–50% | Severe hypoxemia; evidence of right-sided heart failure; radiographic pulmonary fibrosis >50–75% | Life-threatening consequences (e.g., hemodynamic/pulmonary complications); intubation with ventilatory support indicated; radiographic pulmonary fibrosis >75% with severe honeycombing | Death |
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Verma, V.; Simone, C.B., II; Werner-Wasik, M. Acute and Late Toxicities of Concurrent Chemoradiotherapy for Locally-Advanced Non-Small Cell Lung Cancer. Cancers 2017, 9, 120. https://doi.org/10.3390/cancers9090120
Verma V, Simone CB II, Werner-Wasik M. Acute and Late Toxicities of Concurrent Chemoradiotherapy for Locally-Advanced Non-Small Cell Lung Cancer. Cancers. 2017; 9(9):120. https://doi.org/10.3390/cancers9090120
Chicago/Turabian StyleVerma, Vivek, Charles B. Simone, II, and Maria Werner-Wasik. 2017. "Acute and Late Toxicities of Concurrent Chemoradiotherapy for Locally-Advanced Non-Small Cell Lung Cancer" Cancers 9, no. 9: 120. https://doi.org/10.3390/cancers9090120