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Chest Wall Volume Receiving >30 Gy Predicts Risk of Severe Pain and/or Rib Fracture After Lung Stereotactic Body Radiotherapy

医学 放射治疗 毒性 核医学 放射治疗计划 外围设备 肺容积 外科 放射科 内科学
作者
Neal E. Dunlap,Jing Cai,Gregory Biedermann,Wensha Yang,Stanley Benedict,Ke Sheng,Tracey E. Schefter,Brian D. Kavanagh,James M. Larner
出处
期刊:International Journal of Radiation Oncology Biology Physics [Elsevier BV]
卷期号:76 (3): 796-801 被引量:267
标识
DOI:10.1016/j.ijrobp.2009.02.027
摘要

Purpose To identify the dose–volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy. Methods and Materials From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving ≥20, ≥30, ≥40, ≥50, and ≥60 Gy was determined and related to the risk of CW toxicity. Results Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose–response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R2 = 0.9552). A volume threshold of 30 cm3 was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm3 receiving 30 Gy. Conclusion The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to <30 cm3, if possible, to reduce the risk of toxicity without compromising tumor coverage. To identify the dose–volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy. From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving ≥20, ≥30, ≥40, ≥50, and ≥60 Gy was determined and related to the risk of CW toxicity. Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose–response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R2 = 0.9552). A volume threshold of 30 cm3 was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm3 receiving 30 Gy. The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to <30 cm3, if possible, to reduce the risk of toxicity without compromising tumor coverage.
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