Measurement of exhaled nitric oxide and serum surfactant protein D levels for monitoring radiation pneumonitis following thoracic radiotherapy

Yamazaki,Hideya; Aibe,Norihiro; Nakamura,Satoaki; Sasaki,Naomi; Suzuki,Gen; Yoshida,Ken; Yamada,Kei; Koizumi,Masahiko; Arimoto,Taichiro; Iwasaki,Yoshinobu; Kaneko,Yoshiko; Takayama,Koichi

doi:10.3892/ol.2017.6691

Measurement of exhaled nitric oxide and serum surfactant protein D levels for monitoring radiation pneumonitis following thoracic radiotherapy

Authors:
- Hideya Yamazaki
- Norihiro Aibe
- Satoaki Nakamura
- Naomi Sasaki
- Gen Suzuki
- Ken Yoshida
- Kei Yamada
- Masahiko Koizumi
- Taichiro Arimoto
- Yoshinobu Iwasaki
- Yoshiko Kaneko
- Koichi Takayama
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Affiliations: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto, Kyoto 602‑8566, Japan, Department of Radiology, Osaka Medical College, Takatsuki, Osaka 569‑8686, Japan, Department of Radiation Oncology, Division of Health Sciences, Osaka University, Suita, Osaka 565‑0871, Japan, Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto, Kyoto 602‑8566, Japan
Published online on: August 1, 2017 https://doi.org/10.3892/ol.2017.6691
Pages: 4190-4196
Copyright: © Yamazaki et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present study aimed to examine the role of exhaled nitric oxide (eNO) and serum surfactant protein D (SP‑D) level in the determination of radiation pneumonitis (RP) after thoracic radiotherapy (RT). The study included 34 treatments for 33 patients, including 16 three‑dimensional conformal and 18 stereotactic body RT treatments. eNO levels were measured prior to RT, immediately subsequent to RT, every week during the RT course and at 1, 3, 6, 9 and 12 months following the treatment. The therapy reduced the eNO from 24.3±12.8 ppb prior to RT to 19.0±10.4 ppb immediately subsequent to RT (P=0.04). A total of 5 patients (14%) developed symptomatic RP of grade 2 or higher 3‑5 months later, and exhibited an eNO elevation of 2.1±0.68‑fold the minimum value, whereas the RP‑ group exhibited 1.4±0.6‑fold elevation (P=0.02). The sensitivity of a cut‑off of a 1.4‑fold increase in the eNO ratio at the onset of RP was 100%; however, the specificity was 52%, and no predictive alterations to eNO levels were observed prior to the onset of RP. RT was associated with an elevated serum SP‑D level at 3‑6 months after RT. There was a statistically significant difference in the initial serum SP‑D level between RP+ and RP‑ patients. In conclusion, obtaining the eNO ratio was a useful RP monitoring tool but did not predict RP occurrence in the present setting, whereas serum SP‑D level may be a potential predictor for the detection of RP risk.

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