Correlation of dosimetric factors with the development of symptomatic radiation pneumonitis in stereotactic body radiotherapy

Autor: Kaeli K. Samson, Weining Zhen, Michael J. Baine, Ferdinand Osayande, Chi Lin, Joseph Carmicheal, Richard Sleightholm, Dandan Zheng, Jeffrey M. Ryckman, Chi Zhang
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
Male
lcsh:Medical physics. Medical radiology. Nuclear medicine
medicine.medical_specialty
Lung Neoplasms
Adolescent
Stereotactic body radiotherapy
Radiography
medicine.medical_treatment
lcsh:R895-920
Radiosurgery
Effective dose (radiation)
lcsh:RC254-282
030218 nuclear medicine & medical imaging
03 medical and health sciences
Young Adult
0302 clinical medicine
Carcinoma
Non-Small-Cell Lung
Dosimetry
medicine
Humans
Radiology
Nuclear Medicine and imaging
Lung volumes
Radiation treatment planning
Child
Pneumonitis
Aged
Retrospective Studies
Aged
80 and over
business.industry
Research
Interstitial lung disease
Radiotherapy Dosage
Middle Aged
medicine.disease
Prognosis
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Radiation therapy
Oncology
030220 oncology & carcinogenesis
Female
Radiology
Radiotherapy
Intensity-Modulated
Radiation pneumonitis
business
Zdroj: Radiation Oncology, Vol 15, Iss 1, Pp 1-15 (2020)
Radiation Oncology (London, England)
Popis: Background The development of radiation pneumonitis (RP) after Stereotactic Body Radiotherapy (SBRT) is known to be associated with many different factors, although historical analyses of RP have commonly utilized heterogeneous fractionation schemes and methods of reporting. This study aims to correlate dosimetric values and their association with the development of Symptomatic RP according to recent reporting standards as recommended by the American Association of Physicists in Medicine. Methods We performed a single-institution retrospective review for patients who received SBRT to the lung from 2010 to 2017. Inclusion criteria required near-homogeneous tumoricidal (α/β = 10 Gy) biological effective dose (BED10) of 100–105 Gy (e.g., 50/5, 48/4, 60/8), one or two synchronously treated lesions, and at least 6 months of follow up or documented evidence of pneumonitis. Symptomatic RP was determined clinically by treating radiation oncologists, requiring radiographic evidence and the administration of steroids. Dosimetric parameters and patient factors were recorded. Lung volumes subtracted gross tumor volume(s). Wilcoxon Rank Sums tests were used for nonparametric comparison of dosimetric data between patients with and without RP; p-values were Bonferroni adjusted when applicable. Logistic regressions were conducted to predict probabilities of symptomatic RP using univariable models for each radiation dosimetric parameter. Results The final cohort included 103 treated lesions in 93 patients, eight of whom developed symptomatic RP (n = 8; 8.6%). The use of total mean lung dose (MLD) > 6 Gy alone captured five of the eight patients who developed symptomatic RP, while V20 > 10% captured two patients, both of whom demonstrated a MLD > 6 Gy. The remaining three patients who developed symptomatic RP without exceeding either metric were noted to have imaging evidence of moderate interstitial lung disease, inflammation of the lungs from recent concurrent chemoradiation therapy to the contralateral lung, or unique peri-tumoral inflammatory appearance at baseline before treatment. Conclusions This study is the largest dosimetric analysis of symptomatic RP in the literature, of which we are aware, that utilizes near-homogenous tumoricidal BED fractionation schemes. Mean lung dose and V20 are the most consistently reported of the various dosimetric parameters associated with symptomatic RP. MLD should be considered alongside V20 in the treatment planning process. Trial registration Retrospectively registered on IRB 398–17-EP.
Databáze: OpenAIRE
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