Clinical dose–volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC)

Graham, Mary V.; Purdy, James A.; Emami, Bahman; Harms, William B.; Bosch, Walter; Lockett, Mary Ann; Pérez, Carlos A.

doi:10.1016/s0360-3016(99)00183-2

Cited by 1,121 publications

(676 citation statements)

References 21 publications

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“…The masses of lung tissue receiving at least 20 Gy, denoted as M20, were used to assess the potential toxicity of the treatment plans. Our clinical experience has been to use the volume of lung tissue receiving at least 20 Gy (V20) for this purpose (14) . However, in the present study we compared results in an environment in which the density of the lung tissue changed because of respiration.…”

Section: Methodsmentioning

confidence: 99%

Dosimetric benefits of respiratory gating: a preliminary study

Butler

Forster

Stevens

et al. 2004

J Applied Clin Med Phys

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In this study, we compared the amount of lung tissue irradiated when respiratory gating was imposed during expiration with the amount of lung tissue irradiated when gating was imposed during inspiration. Our hypothesis was that the amount of lung tissue spared increased as inspiration increased. Computed tomography (CT) image data sets were acquired for 10 patients diagnosed with primary bronchogenic carcinoma. Data sets were acquired during free breathing, during breath‐holds at 0% tidal volume and 100% tidal volume, and, when possible, at deep inspiration corresponding to approximately 60% vital capacity. Two treatment plans were developed on the basis of each of the gated data sets: one in which the treatment portals were those of the free‐breathing plan, and the other in which the treatment portals were based on the gated planning target volumes. Dose‐mass histograms of the lungs calculated at 0% tidal volume were compared to those calculated at deep inspiration and at 100% tidal volume. Data extracted from the dose‐mass histograms were used to determine the most dosimetrically beneficial point to gate, the reduction in the amount of irradiated lung tissue that resulted from gating, and any disease characteristics that might predict a greater need for gating. The data showed a reduction in the mass of normal tissue irradiated when treatment portals based on the gated planning target volume were used. More normal lung tissue was spared at deep inspiration than at the other two gating points for all patients, but normal lung tissue was spared at every point in the respiratory cycle. No significant differences in the amount of irradiated tissue by disease characteristic were identified. Respiratory gating of thoracic radiation treatments can often improve the quality of the treatment plan, but it may not be possible to determine which patients may benefit from gating prior to performing the actual treatment planning.PACS numbers 87.53 –j; 87.53.Tf

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Section: Methodsmentioning

confidence: 99%

Dosimetric benefits of respiratory gating: a preliminary study

Butler

Forster

Stevens

et al. 2004

J Applied Clin Med Phys

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“…Several studies have successfully correlated the risk of developing RT-induced lung injury with 3D dose parameters such as mean lung dose (MLD) and the percentage of lung volume receiving ≥ 20 Gy (V20) [4,[7][8][9][10][11]. These findings are encouraging, in that they demonstrate the ability of 3D tools to predict normal tissue risks [9].…”

Section: Introductionmentioning

confidence: 92%

“…For patients treated for lung cancer, approximately 5% to 20% develop symptomatic lung injury, 50% to 100% develop radiologic evidence of regional injury, and 50% to 90% experience declines in pulmonary function [1][2][3][4][5][6]. Identification of the dosimetric and biologic determinants of RTinduced lung injury would be useful in developing risk profiles for individual patients; thereby tailoring treatment to maximize efficacy and minimize toxicity [1].…”

Section: Introductionmentioning

confidence: 99%

Does transforming growth factor-β1 predict for radiation-induced pneumonitis in patients treated for lung cancer?

et al. 2006

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The purpose of the study was to reassess the utility of transforming growth factor-beta-1 (TGF-β1) together with dosimetric and tumor parameters as a predictor for radiation pneumonitis (RP). Of the 121 patients studied, 32 (26.4%) developed grade ≥ 1 RP, and 27 (22.3%) developed grade ≥ 2 RP. For the endpoint of grade ≥ 1 RP, those with V30 > 30% and an end-RT/baseline TGF-β1 ratio ≥ 1 had a significantly higher incidence of RP than did those with V30 > 30% and an end-RT/baseline TGF-β1 ratio < 1. For most other patient groups, there were no clear associations between TGF-β1 values and rates of RP. These findings suggest that TGF-β1 is generally not predictive for RP except for the group of patients with a high V30.

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“…A study reported by Kwa et al (34) that included 540 patients, found no radiation pneumonitis for 64 patients who received a mean lung dose up to 8 Gy, which is higher than the 5.57 Gy mean lung dose (Gy) by our MP‐VMAT design. The probability of developing Grade 2 radiation pneumonitis was low for patients who had less than 22% of normal lung volume irradiated with more than 20 Gy (35) . The evaluation of TLV in our treatment design showed

V_{10}

was significantly lower than the criteria reported by Graham et al, (35) and the

V_{5}

was comparable to the FIF technique reported by Goddu et al (18) Based on these evaluation results on lungs, the likelihood of developing radiation‐induced pneumonitis by our MP‐VMAT design is extremely low.…”

Section: Discussionmentioning

confidence: 95%

The feasibility study of using multiple partial volumetric‐modulated arcs therapy in early stage left‐sided breast cancer patients

Tsai

Lin

Lee

et al. 2012

J Applied Clin Med Phys

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The purpose of this study was to assess the feasibility of using a multiple partial volumetric‐modulated arcs therapy (MP‐VMAT) technique on the left breast irradiation and to evaluate the dosimetry and treatment efficiency. Ten patients with left‐sided breast cancer who had been treated by whole breast irradiation were selected for the treatment plan evaluation by using six partial volumetric modulated arcs. Each arc consisted of a 50° gantry rotation. The planning target volumes and the normal organs, including the right breast, the bilateral lungs, left ventricle, heart, and unspecified tissue, were contoured on the CT images. Dose‐volume histograms were generated and the delivery time for each arc was recorded. The PTV received greater than 95% of the V95 for all cases, and the maximum dose was within ±1% of 110% of the prescription dose. The mean homogeneity index (HI) was 10.61±0.99, and mean conformity index (CI) was 1.21±0.03. The mean dose, V5, V10, V25, and V30 of the heart were 7.61±1.38 Gy, 59.73% ±15.87%, 24.39% ±6.82%, 2.52% ±1.11%, and 1.57% ±0.71%, respectively. The volume of the left ventricle receiving 25 Gy was 5.15% ±2.23%. The total lung mean dose was 5.57±0.36 Gy, with V5 of 25.39% ±3.88% and V20 of 5.66% ±0.89%. The right breast received a mean dose of 2.13±0.22 Gy, with V5 of 1.83% ±1.22% and V10 of 0.04% ±0.12%. The mean dose of unspecified tissue was 5.34±0.37 Gy and V5 was 22.23% ±1.57%. The volume of the unspecified tissue receiving 50 Gy was 0.50% ±0.14%. The mean delivery time for each arc was 13.9 seconds. The average MU among ten patients was 511 MU (range 443 to 594 MUs). The MP‐VMAT technique for the left‐sided breast cancer patients achieved adequate target dose coverage while maintaining low doses to organs‐at‐risk, and therefore reduced the potential for induction of second malignancy and side effects. The highly efficient treatment delivery would be beneficial for improving patient throughput, providing patient comfort, and achieving precise treatment with the breathing control system.PACS number: 87.55.‐x, 87.55.D‐, 87.55.dk

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Clinical dose–volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC)

Cited by 1,121 publications

References 21 publications

Dosimetric benefits of respiratory gating: a preliminary study

Dosimetric benefits of respiratory gating: a preliminary study

Does transforming growth factor-β1 predict for radiation-induced pneumonitis in patients treated for lung cancer?

The feasibility study of using multiple partial volumetric‐modulated arcs therapy in early stage left‐sided breast cancer patients

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