Publications [#144319] of Christopher R Kelsey

Papers Published

1. CR Kelsey, D Kahn, DR Hollis, KL Miller, SM Zhou, RW Clough, LB Marks, Radiation-induced narrowing of the tracheobronchial tree: an in-depth analysis., Lung cancer (Amsterdam, Netherlands), vol. 52 no. 1 (April, 2006), pp. 111-6, ISSN 0169-5002 [doi]
   (last updated on 2013/05/16)

   Abstract:
   OBJECTIVE: Symptomatic narrowing of the tracheobronchial tree is not a common clinical problem after conventional-dose external beam radiation therapy but has been described when higher doses are utilized. This in-depth study quantifies changes in the caliber of the trachea and mainstem bronchi after high-dose external beam radiation therapy (EBRT). METHODS: As part of an IRB-approved prospective clinical trial to assess for radiation-induced lung injury, patients with thoracic malignancies had pre- and serial post-RT CT scans in the radiation oncology department. This report focuses on 18 enrolled patients who received high-dose (> or = 73.6 Gy) EBRT for NSCLC. The caliber of the trachea, right mainstem bronchus, and left mainstem bronchus were measured utilizing three-dimensional coordinates in axial and coronal planes such that multiple measurements were made of each structure. The decrease in airway caliber was tested for significance using a one-sided Wilcoxon matched-pairs signed-ranks test. The correlation between airway caliber changes, dose, and follow-up interval was tested using the Spearman rank correlation coefficient and the effect of chemotherapy on airway narrowing was evaluated with a one-sided exact Wilcoxon rank sum test. RESULTS: There was no significant narrowing of the trachea for all dose and time points. There were significant decreases in the caliber of both mainstem bronchi on axial measurements (p = 0.07 and 0.005 for right and left mainstem bronchi, respectively). Decrease in airway caliber ranged from 6 to 57% and appeared to be dose dependent (p = 0.08), progressed with increasing time post-RT (p = 0.04), and was worse in patients who also received chemotherapy (p = 0.04). CONCLUSIONS: High-dose EBRT (> or = 73.6 Gy) appears to cause narrowing of the mainstem bronchi as early as 3 months post radiation therapy. Additional study is needed to assess the impact of such narrowing on RT-induced pulmonary symptoms.

   Keywords:
   Aged • Bronchi • Constriction, Pathologic • Female • Humans • Lung Injury* • Lung Neoplasms • Male • Middle Aged • Prospective Studies • Radiation Injuries • Radiotherapy Dosage • Trachea • complications* • etiology* • radiation effects* • radiotherapy*