46 Chapter 4 Results All new cardiopulmonary complications during follow up are summarized in Table 3. Radiological changes in the lungs were only scored as radiation pneumonitis if they remained after the use of antibiotics. In 60 out of 216 patients (27.8%), radiologic features of radiation-induced pneumonitis were observed on follow up CT scans. 3 patients experienced clinical symptoms requiring steroids (grade 2), 6 of them were hospitalized (grade 3), another 4 patients eventually died of this complication (grade 5). Table 3 Follow up and toxicity New pulmonary events Radiation pneumonitis grade 1 47(22%) Radiation pneumonitis grade 2 3(1%) Radiation pneumonitis grade 3 6(3%) Radiation pneumonitis grade 4 0(0%) Radiation pneumonitis grade 5 4(2%) New cardiac events Pericardial effusion grade 2 60(28%) Pericardial effusion grade 3 9(4%) Angina pectoris any grade 3(1%) Myocardial infarction any grade 4(2%) Heart failure any grade 8(4%) Arythmia any grade 8(4%) Valvular disease any grade 1(0%) Survival status at last FU Alive, no evidence of disease 105(49%) Alive with recurrent disease 33(15%) Dead by index tumor 57(26%) Dead by toxicity 5(2%) Dead intercurrent disease 16(7%) Univariate logistic regression analysis showed that most lung dose parameters and some cardiac substructure dose parameters were significantly associated with pneumonitis. Of the clinical factors, only diabetes mellitus (DM) was associated with this endpoint (suppl. data figure 7). Multivariable logistic regression analysis showed that radiation pneumonitis was best predicted by the mean lung dose (MLD) only, with an odds ratio of 1.18 per Gy MLD (this model had an AUC of 0.67 (adjusted AUC after bootstrapping = 0.63)).
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