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Angiotensin-converting enzyme inhibitors decrease the risk of radiation pneumonitis after stereotactic body radiation
Eileen M Harder1, Henry S Park1, Sameer K Nath1
1Department of Therapeutic Radiology Yale University School of Medicine, Yale Cancer Center, New Haven, Connecticut.
Practical Radiation Oncology
|September 29, 2015
Summary
Angiotensin-converting enzyme (ACE) inhibitor use during stereotactic body radiation therapy (SBRT) for lung cancer significantly reduced the risk of radiation pneumonitis (RP). This protective effect warrants further investigation in prospective studies.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- Angiotensin-converting enzyme (ACE) inhibitors are known to reduce radiation pneumonitis (RP) risk in conventional radiation therapy.
- This protective effect has not been established for stereotactic body radiation therapy (SBRT).
Purpose of the Study:
- To investigate the impact of ACE inhibitor use during SBRT on the risk of symptomatic (grade ≥2) RP in lung cancer patients.
Main Methods:
- Retrospective analysis of 257 lung cancer patients treated with SBRT.
- Examined use of ACE inhibitors and other medications.
- Assessed RP using Common Terminology Criteria for Adverse Events (CTCAE) v4.0.
- Kaplan-Meier and Cox proportional hazards modeling were used for analysis.
Main Results:
- ACE inhibitor users (27.2%) had significantly lower rates of symptomatic RP compared to nonusers (19.1% vs 76.3% at 12 months).
- Multivariate analysis confirmed ACE inhibitor use as protective (HR 0.373, P=.026), independent of pulmonary radiation dose.
- Pulmonary dose metrics were also significant predictors of RP.
Conclusions:
- ACE inhibitor use during SBRT is associated with reduced symptomatic RP.
- Prospective studies are recommended to confirm these findings and explore the protective mechanisms.
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