Decreased risk of radiation pneumonitis with concurrent use of renin-angiotensin system inhibitors in thoracic radiation therapy of lung cancer

Yawen Zheng; Changsheng Cong; Zewen Wang; Yanan Liu; Mingyan Zhang; Hao Zhou; Chen Su; Meili Sun

doi:10.3389/fmed.2023.1255786

Decreased risk of radiation pneumonitis with concurrent use of renin-angiotensin system inhibitors in thoracic radiation therapy of lung cancer

Front Med (Lausanne). 2023 Oct 12:10:1255786. doi: 10.3389/fmed.2023.1255786. eCollection 2023.

Authors

Yawen Zheng¹, Changsheng Cong¹, Zewen Wang¹, Yanan Liu², Mingyan Zhang², Hao Zhou¹, Chen Su¹, Meili Sun^{1

2}

Affiliations

¹ Department of Oncology, Central Hospital Affiliated To Shandong First Medical University, Jinan, China.
² Department of Oncology, Jinan Central Hospital, Shandong University, Jinan, China.

Abstract

Background: Radiation pneumonitis (RP) is the primary dose-limiting toxicity associated with radiotherapy. This study aimed to observe the effects of renin-angiotensin system inhibitors in Chinese patients with lung cancer who received thoracic radiation.

Methods: Patients with lung cancer who received thoracic radiation at a total dose of ≥45 Gray between October 2017 and December 2022 were enrolled in this study. We retrospectively evaluated the factors influencing grade 2 or higher RP.

Results: A total of 320 patients were enrolled in this study; 62 patients were identified as angiotensin receptor blockers or angiotensin-converting enzyme inhibitor users. Additionally, 99 patients (30.9%) had grade 2 or higher RP, and the incidence in the renin-angiotensin system inhibitor group was 17.7% (11 out of 62 patients). Patients in the renin-angiotensin system inhibitors (RASi) group were older and had a higher percentage of males, lower percentage of ECOG score 0, higher percentage of hypertension, and higher percentage of adenocarcinoma than those in the non-RASi group. ECOG score [hazard ratio (HR) = 1.69, p = 0.009], history of smoking (HR = 1.76, p = 0.049), mean dose (HR = 3.63, p = 0.01), and RASi (HR = 0.3, p = 0.003) were independent predictive factors for RP. All subgroups benefited from RASi.

Conclusion: This study showed that oral RASi administration has the potential to mitigate the incidence of grade 2 or higher RP in patients with lung cancer undergoing thoracic radiotherapy. To validate and further substantiate these findings, additional prospective research is warranted.

Keywords: lung cancer; predictive factors; radiation pneumonitis; renin-angiotensin system inhibitors; thoracic radiation.

Grants and funding

This work was financially supported by grants from the Shandong Natural Science Foundation (ZR2021QH034), Beijing Kechuang Medical Development Foundation (KC2021-JX-0186-68), China Postdoctoral Science Foundation (2023 M731305) and Postdoctoral Innovation Project of Shandong Province (2021-64).