Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Decreased Risk of Radiation Pneumonitis With Coincident Concurrent Use of Angiotensin-converting Enzyme Inhibitors in Patients Receiving Lung Stereotactic Body Radiation Therapy

Alite, Fiori, MD*; Balasubramanian, Neelam, BA*; Adams, William, MA*; Surucu, Murat, PhD*; Mescioglu, Ibrahim, PhD; Harkenrider, Matthew, M., MD*

American Journal of Clinical Oncology: June 2018 - Volume 41 - Issue 6 - p 576–580
doi: 10.1097/COC.0000000000000324
Original Articles: Thoracic

Objectives: Angiotensin-converting enzyme inhibitors (ACEi) have demonstrated decreased rates of radiation-induced lung injury in animal models and clinical reports have demonstrated decreased pneumonitis in the setting of conventionally fractionated radiation to the lung. We tested the role of ACEi in diminishing rates of symptomatic (grade ≥2) pneumonitis in the setting of lung stereotactic body radiation therapy (SBRT).

Methods: We analyzed patients treated with thoracic SBRT to 48 to 60 Gy in 4 to 5 fractions from 2006 to 2014. We reviewed pretreatment and posttreatment medication profiles to document use of ACEi, angiotensin receptor blockers, bronchodilators, aspirin, PDE-5 inhibitors, nitrates, and endothelin receptor antagonists. Pneumonitis was graded posttreatment based on Common Terminology Criteria for Adverse Events Version 4.0. Univariate and multivariate analysis was performed and time to development of pneumonitis was evaluated by the Kaplan-Meier method.

Results: A total of 189 patients were evaluated with a median follow-up of 24.8 months. The overall 1-year rate of symptomatic pneumonitis was 13.2%. The 1-year rate of symptomatic pneumonitis was 4.2% for ACEi users versus 16.3% in nonusers (P=0.03). On univariate analysis, the odds of developing grade 2 or greater pneumonitis were significantly lower for patients on ACEi (P=0.03). On multivariate analysis, after controlling for clinicopathologic characteristics and dosimetric endpoints, there was a significant association between ACEi use and decreased risk of clinical pneumonitis (P=0.04). Angiotensin receptor blockers or other bronchoactive medications did not show significant associations with development of pneumonitis.

Conclusions: Incidental concurrent use of ACEi demonstrated efficacy in diminishing rates of symptomatic pneumonitis in the setting of lung SBRT.

*Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Stritch School of Medicine Loyola University Chicago, Maywood

Department of Statistics, Lewis University, Romeoville, IL

The authors declare no conflicts of interest.

Reprints: Matthew M. Harkenrider, MD, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Stritch School of Medicine Loyola University Chicago, 2160 S 1st Ave, Maguire Center, Rm 2932, Maywood, IL 60153. E-mail: mharkenrider@lumc.edu.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.