PhD ceremony Mr. E.M. Wiegman: Prediction and prevention of radiation-induced lung toxicity

PhD ceremony: Mr. E.M. Wiegman

Dissertation: Prediction and prevention of radiation-induced lung toxicity

Promotor(s): prof. R.P. Coppes, prof. H.H. Kampinga, prof. J.A. Langendijk

Faculty: Medical Sciences

Concurrent chemo radiotherapy is considered treatment of choice for locally advanced non–small-cell lung cancer. However, the dose that can be safely applied to the tumour is limited by the risk of Radiation Induced Lung Toxicity (RILT). Up to 20% of patients treated with a curative dose may have symptoms and signs of RILT. RILT may present in two phases: acute inflammatory pneumonitis, occurring 6-12 weeks after radiotherapy and late pulmonary fibrosis, occurring months to years after treatment. Clinical symptoms range from mild dyspnea and non-productive cough to respiratory failure requiring assisted ventilation. This thesis focuses on how to improve the prediction of RILT, as well as ways to prevent it.

It was shown that regional differences in lung radio sensitivity exists in a pre-clinical model, and that chemotherapy may influence the development of radiation induced lung toxicity. Next, we showed the applicability of a new tool to assess radiological signs of RILT in a clinical setting. The data in this thesis may contribute to the development of new models to better estimate the risk of radiation induced lung toxicity and to identify poten¬tial treatment strategies. More accurate predictive models will allow dose esca¬lation aiming at improved tumour control and survival in lung cancer patients, without jeopardizing patient’s health.