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

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

JOURNAL=Frontiers in Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1255786

DOI=10.3389/fmed.2023.1255786

ISSN=2296-858X

ABSTRACT=<sec id="sec1"><title>Background</title><p>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.</p></sec><sec id="sec2"><title>Methods</title><p>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.</p></sec><sec id="sec3"><title>Results</title><p>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, <italic>p</italic> = 0.009], history of smoking (HR = 1.76, <italic>p</italic> = 0.049), mean dose (HR = 3.63, <italic>p</italic> = 0.01), and RASi (HR = 0.3, <italic>p</italic> = 0.003) were independent predictive factors for RP. All subgroups benefited from RASi.</p></sec><sec id="sec4"><title>Conclusion</title><p>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.</p></sec>