Serum amyloid a as a predictive marker for radiation pneumonitis in lung cancer patients.

Yu-Shan Wang, Heng-Jui Chang, Yue-Cune Chang, Su-Chen Huang, Hui-Ling Ko, Chih-Chia Chang, Yu-Wung Yeh, Jiunn-Song Jiang, Cheng-Yen Lee, Mau-Shin Chi, Kwan-Hwa Chi

Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.

International journal of radiation oncology, biology, physics 2013 Mar 1

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To investigate serum markers associated with radiation pneumonitis (RP) grade ≥3 in patients with lung cancer who were treated with radiation therapy. Pretreatment serum samples from patients with stage Ib-IV lung cancer who developed RP within 1 year after radiation therapy were analyzed to identify a proteome marker able to stratify patients prone to develop severe RP by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Dosimetric parameters and 3 biological factors were compared. Serum samples from 16 patients (28%) with severe RP (grade 3-4) and 42 patients (72%) with no or mild RP (grade 0-2) were collected for analysis. All patients received a median of 54 Gy (range, 42-70 Gy) of three-dimensional conformal radiation therapy with a mean lung dose (MLD) of 1502 cGy (range, 700-2794 cGy). An m/z peak of 11,480 Da was identified by SELDI-TOF-MS, and serum amyloid A (SAA) was the primary splitter serum marker. The receiver operating characteristic area under the curve of SAA (0.94; 95% confidence interval [CI], 0.87-1.00) was higher than those of C-reactive protein (0.83; 95% CI, 0.72-0.94), interleukin-6 (0.79; 95% CI, 0.65-0.94), and MLD (0.57; 95% CI, 0.37-0.77). The best sensitivity and specificity of combined SAA and MLD for predicting RP were 88.9% and 96.0%, respectively. Baseline SAA could be used as an auxiliary marker for predicting severe RP. Extreme care should be taken to limit the lung irradiation dose in patients with high SAA. Copyright © 2013 Elsevier Inc. All rights reserved.

Citation

Yu-Shan Wang, Heng-Jui Chang, Yue-Cune Chang, Su-Chen Huang, Hui-Ling Ko, Chih-Chia Chang, Yu-Wung Yeh, Jiunn-Song Jiang, Cheng-Yen Lee, Mau-Shin Chi, Kwan-Hwa Chi. Serum amyloid a as a predictive marker for radiation pneumonitis in lung cancer patients. International journal of radiation oncology, biology, physics. 2013 Mar 1;85(3):791-7