Chonnam Med J.  2010 Apr;46(1):19-24. 10.4068/cmj.2010.46.1.19.

Risk Factors for Fatal Hemoptysis after Concurrent Chemoradiation Therapy in Patients with Non-Small Cell Lung Carcinoma

• Kim YH
• Kim EY
• Ban HJ
• Oh IJ
• Kim KS
• Kim YC
• Ahn SJ

• KMID: 2172252
• DOI: http://doi.org/10.4068/cmj.2010.46.1.19

Abstract

Massive hemoptysis is a serious complication leading to death in lung cancer patients. To investigate whether fatal hemoptysis is associated with concurrent chemoradiation therapy (CCRT), the authors retrospectively analyzed risk factors for fatal hemoptysis after CCRT. The records of 150 patients (129 men and 21 women) with non-small cell lung cancer (NSCLC) who were treated with CCRT from April 2004 to June 2007 were reviewed for toxicity-related fatal hemoptysis. The dose of radiation ranged from 2500 to 9660 cGy, with a mean dose of 6506 cGy. Paclitaxel (45 mg/m2), docetaxel (20 mg/m2), or gemcitabine (350 mg/m2) with cisplatin 20 mg/m2 given weekly for 6 weeks during radiation therapy. Out of 150 patients, 12 (8.0%) patients died of fatal hemoptysis, and all but three had central and squamous tumors. Most of them had radiation pneumonitis or fibrosis. Median time to fatal hemoptysis after CCRT was 9.6 months, ranging from 84 days to 22 months. From a univariate analysis, the significant clinical factors for fatal hemoptysis were central location (p=0.004), central & squamous tumor (p=0.004), poor performance status (p=0.018), and chemotherapy with gemcitabine (p=0.017). From a multivariate analysis, poor performance status (OR=6.698, 95% CI, 1.083~41.430, p=0.041) and central location (OR=6.976, 95% CI, 1.414~34.430, p=0.017) were independent risk factors. Centrally located tumors and poor performance status have been found to be significantly associated with fatal hemoptysis in NSCLC patients treated with CCRT.

Keyword

Hemoptysis; Lung neoplasms; Drug therapy; Radiotherapy

MeSH Terms

Carcinoma, Non-Small-Cell Lung
Cisplatin
Deoxycytidine
Fibrosis
Hemoptysis
Humans
Lung
Lung Neoplasms
Male
Multivariate Analysis
Paclitaxel
Radiation Pneumonitis
Retrospective Studies
Risk Factors
Taxoids
Cisplatin
Deoxycytidine
Paclitaxel
Taxoids

Figure

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  Fig. 1 Sixty two-year old man with locally advanced NSCLC treated with concurrent chemoradiation therapy. (A) Chest CT scan with lung parenchymal window shows ground glass opacities associated with consolidation representing radiation pneumonitis. (B) Bronchoscopy performed prior to fatal hemoptysis in a patient who died of fatal toxicity demonstrats whitish necrotic material covering bronchial mucosa indicative of radiation induced bronchial injury.

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