Journal of Radiation Oncology

, Volume 8, Issue 2, pp 209–216 | Cite as

A risk model for lung complication combining radiation therapy and chronic obstructive pulmonary disease

  • Roman O. KowalchukEmail author
  • Daniel M. Trifiletti
  • Shiv R. Khandelwal
  • James M. Larner
  • W. Tyler Watkins
Original Research



To develop a multi-variate risk model of lung complication for the treatment of locally advanced lung cancer combining radiation dosimetry and patient-specific risk factors including chronic obstructive pulmonary disease (COPD).


A retrospective study of 89 advanced lung cancer patients including clinical variables and radiation dose-volume metrics was correlated to overall survival (OS), local progression-free survival (LPFS), and lung complications. Lung toxicities were defined as grade 2 or higher lung complication including persistent cough requiring narcotic or antitussive agents, and dyspnea with minimal effort but not at rest. Grade 2 or higher radiation pneumonitis (RP) was defined clinically or radiographically. Each observed complication was correlated to the set of patient-specific factors via regression.


Age was the dominant factor in survival analysis; in patients > 70, 2-year survival was 28% (N = 18) vs. 59% in patients < 70 (N = 71, HR = 3.9, p = 0.004). OS and LPFS were not significantly different based on with COPD status (p = 0.2, HR = 1.5) or radiation dose (range 40–74 Gy, median = 60 Gy, p > 0.5, HR < 1.3). In predicting all observed lung complications, multi-variate stepwise logistic regression revealed COPD status (p = 0.01) and a total lung V50 (p = 0.02) as significant. Separation of G2 or higher lung complication and RP showed a different trend, with G2 or higher lung complication statistically associated with age (p = 0.02) and COPD (p = 0.03). Radiation pneumonitis was only associated with total lung volume at 20 Gy (V20, p = 0.003), with a resulting model risk (RP) = 1.4 (V20-0.21).


COPD status was not associated with survival or radiation pneumonitis. Age was the dominant factor in survival, and total lung V20 was associated with risk of RP.


Lung cancer COPD Pneumonitis Lung complication 


Compliance with ethical standards


William Watkins has received funding from the University of Virginia Ivy foundation for this project. The University of Virginia Ivy biomedical Innovation grant supported this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Roman O. Kowalchuk
    • 1
    Email author
  • Daniel M. Trifiletti
    • 1
    • 2
  • Shiv R. Khandelwal
    • 1
  • James M. Larner
    • 1
  • W. Tyler Watkins
    • 1
  1. 1.Department of Radiation OncologyUniversity of VirginiaCharlottesvilleUSA
  2. 2.Radiation Oncology, Mayo Clinic JacksonvilleUSA

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