Abstract:
Objective To analyze the prophylactic effect of pirfenidone on radiation pneumonitis in patients with esophageal cancer during radiotherapy.
Methods The data of patients with esophageal cancer treated with intensity-modulated radiation therapy (IMRT) from November 2017 to January 2020 in Fujian Medical University Union Hospital were retrospectively collected. Patients were assigned into two groups: the pirfenidone group and the control group, according to the use of pirfenidone. Propensity score-based inverse probability of treatment weighting (IPTW) was used to analyze differences in the incidence rates of grade ≥2 and grade ≥3 radiation pneumonitis between two groups.
Results In total, 170 patients with esophageal cancer treated with IMRT were included. Forty patients were included in the pirfenidone group, and 130 patients were included in the control group. The median follow-up duration was 22.6 months. These factors included age, history of pirfenidone use, radiotherapy dose, and the percent of the total lung volume exceeding 5Gy (V5) and V20. After IPTW analysis, the difference in baseline characteristics between the two groups decreased by 99.72%. The incidence rates of grade ≥2 and grade ≥3 radiation pneumonitis were 3.92% vs. 14.73% (P=0.000 7) and 3.92% vs. 10.99% (P=0.014 1) in the pirfenidone group vs. control group, respectively. Multivariate Logistic regression analysis showed that pirfenidone use (grade 2: P=0.001 7, grade 3: P=0.019 1), age (grade 2: P=0.033 6, grade 3: P=0.002 8), and radiotherapy dose (grade 2: P=0.011 9, grade 3: P =0.003 1) were associated with the incidence of grade ≥2 and grade ≥3 radiation pneumonitis. No significant adverse reactions were found in the pirfenidone group.
Conclusions In patients with esophageal cancer treated with IMRT, the concurrent use of pirfenidone during radiotherapy can effectively reduce the incidence of grade ≥2 and grade ≥3 radiation pneumonitis, with good safety. However, further clinical studies are needed.
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