Cardiac and Pulmonary Dosimetric Parameters in Patients With Lung Cancer Undergoing Postoperative Radiation Therapy Across a Statewide Consortium.

Autor:	Herr DJ; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Yin H; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Allen SG; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Bergsma D; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; St. Mary's Hospital, Lacks Cancer Center, Grand Rapids, Michian., Dragovic AF; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Brighton Center for Specialty Care, Brighton, Michigan., Dess RT; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Matuszak M; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Grubb M; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Dominello M; Department of Radiation Oncology, Karmanos Cancer Institute, Detroit, Michigan., Movsas B; Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan., Kestin LL; MHP Radiation Oncology Institute/GenesisCare USA, Farmington Hills, Michigan., Hayman JA; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Paximadis P; Department of Radiation Oncology, Spectrum Health Lakeland, St. Joseph, Michigan., Schipper M; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan., Jolly S; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: shrutij@med.umich.edu.
Jazyk:	angličtina
Zdroj:	Practical radiation oncology [Pract Radiat Oncol] 2023 May-Jun; Vol. 13 (3), pp. e254-e260. Date of Electronic Publication: 2023 Feb 06.
DOI:	10.1016/j.prro.2023.01.010
Abstrakt:	Purpose: The recently published Lung Adjuvant Radiotherapy Trial (Lung ART) reported increased rates of cardiac and pulmonary toxic effects in the postoperative radiation therapy (PORT) arm. It remains unknown whether the dosimetric parameters reported in Lung ART are representative of contemporary real-world practice, which remains relevant for patients undergoing PORT for positive surgical margins. The purpose of this study was to examine heart and lung dose exposure in patients receiving PORT for non-small cell lung cancer across a statewide consortium. Methods and Materials: From 2012 to 2022, demographic and dosimetric data were prospectively collected for 377 patients at 27 academic and community centers within the Michigan Radiation Oncology Quality Consortium undergoing PORT for nonmetastatic non-small cell lung cancer. Dosimetric parameters for target coverage and organ-at-risk exposure were calculated using data from dose-volume histograms, and rates of 3-dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) utilization were assessed. Results: Fifty-one percent of patients in this cohort had N2 disease at the time of surgery, and 25% had a positive margin. Sixty-six percent of patients were treated with IMRT compared with 32% with 3D-CRT. The planning target volume was significantly smaller in patients treated with 3D-CRT (149.2 vs 265.4 cm 3 ; P < .0001). The median mean heart dose for all patients was 8.7 Gy (interquartile range [IQR], 3.5-15.3 Gy), the median heart volume receiving at least 5 Gy (V5) was 35.2% (IQR, 18.5%-60.2%), and the median heart volume receiving at least 35 Gy (V35) was 9% (IQR, 3.2%-17.7%). The median mean lung dose was 11.4 Gy (IQR, 8.1-14.3 Gy), and the median lung volume receiving at least 20 Gy (V20) was 19.6% (IQR, 12.7%-25.4%). These dosimetric parameters did not significantly differ by treatment modality (IMRT vs 3D-CRT) or in patients with positive versus negative surgical margins. Conclusions: With increased rates of IMRT use, cardiac and lung dosimetric parameters in this statewide consortium were slightly lower than those reported in Lung ART. These data provide useful benchmarks for treatment planning in patients undergoing PORT for positive surgical margins. (Copyright © 2023 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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