Dose–volume thresholds and smoking status for the risk of treatment-related pneumonitis in inoperable non-small cell lung cancer treated with definitive radiotherapy

Jin, He; Tucker, Susan L.; Liu, Hui Helen; Xiong, Wei; Yom, Sue S.; Wang, Shulian; Komaki, Ritsuko; Chen, Yuhchyau; Martel, Mary K.; Mohan, Radhe; Cox, James D.; Liao, Zhongxing

doi:10.1016/j.radonc.2008.09.009

Cited by 133 publications

(128 citation statements)

References 29 publications

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“…by means of Radiation Therapy Oncology Group (RTOG) grade 1 [17], RTOG grade 2 [17,18], CTCAE v. 2.0 [19,20], CTCAE v. 3.0 [21] and Southwest Oncology Group (SWOG) grade 2 [22]. Mean lung dose (MLD) was also reported to be a significant factor by means of RTOG grade 1 [17], RTOG grade 2 [17], RTOG grade 3 [23], CTCAE v.1.0 [24], CTCAE v.2.0 [20] and SWOG grade 2 [25].…”

Section: Dosimetric Factors For Radiation Pneumonitis After Conventiomentioning

confidence: 99%

“…Recently, lung volumes that were treated with doses .5 Gy were also found to be significant factors in CFRT with chemotherapy [26,27]. In addition, Jin et al [21] studied grade $3 RPs by CTCAE v.3.0 and showed threshold DVH curves defined by V20 #25%, V25 #20%, V35 #15% and V50 #10%. Patients with lung DVHs satisfying these constraints had only a 2% incidence of grade $3 RP.…”

Section: Dosimetric Factors For Radiation Pneumonitis After Conventiomentioning

confidence: 99%

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Comparison of clinical, tumour-related and dosimetric factors in grade 0–1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours

Takeda

Ohashi²,

Kunieda

et al. 2012

BJR

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Objective: The aim of this study was to investigate significant clinical, tumour-related and dosimetric factors among patients with grade 0-1, grade 2 and grade 3 radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT) for lung tumours. Methods: Patients (n5128) with a total of 133 lung tumours treated with SBRT of 50 Gy in 5 fractions were analysed. RP was graded according to the Common Terminology Criteria for Adverse Events v.3.0. Significant factors were identified by univariate and multivariate analyses. Threshold dose-volume histograms (DVHs) were constructed to identify the incidence of RP. Results: The median follow-up period was 12 months (range, 6-45 months). In univariate analyses, gender, operability, forced expiratory volume in 1 s (FEV1), internal target volume, lung volumes treated with doses .5-30 Gy (V5-30) and mean lung dose were significant factors differentiating between grade 0-1 and grade 2 RP, and V15-30 were significant factors differentiating between grade 2 and grade 3. However, no factors were significant between grade 0-1 and grade 3 RP. Multivariate analysis showed that female gender, high FEV1 and high V15 were significant factors differentiating between grade 0-1 and grade 2 RP. Threshold DVH curves were created based on #5% and #15% risk of grade 2 RP among patients with grade 0-2 RP. Conclusions: Grade 0-2 RP was dose-volume dependent, and female gender and high FEV1 were significant predictive clinical factors for grade 2 RP among patients with grade 0-2 RP. However, incidences of V15-30 in grade 3 RP were significantly lower than those in grade 2 RP, and no significant clinical or tumour-related factors were found. Further studies are needed to identify the mechanism underlying the development of grade 3 RP after SBRT for lung tumours. Previously, we investigated the clinical and dosimetric factors that correlate with severe radiation pneumonitis (RP) in patients with lung tumours treated with stereotactic body radiotherapy (SBRT) [1]. We found that, among a variety of factors, only a short latent period was a significant correlate of severe RP.Other reports [2][3][4][5][6] have also analysed the clinical and dosimetric factors correlated with RP after SBRT. Various dosimetric factors were reported to significantly correlate with RP after SBRT, which included the mean dose in the ipsilateral lung, V7 and V10 by Kyas et al [2], normal tissue complication probability (NTCP) by Ricardi et al [3], lung volumes treated with doses higher than 2.5-50 Gy (V2.5-50) by Guckenberger et al [4], mean lung dose by Barriger et al [5] and contralateral V5 by Ong et al [6].We found a discrepancy in the significant clinical and dosimetric factors between the results of these five studies on low-grade RP [2-6] and our study on severe RP [1]. We speculated that the mechanism underlying the development of grade $3 RP might be different from that of grade 2 RP. Additionally, the treatment of grade $3 RP was much more critical than that of grade 2 RP. Most patients with grade $3 RP nee...

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Section: Dosimetric Factors For Radiation Pneumonitis After Conventiomentioning

confidence: 99%

Section: Dosimetric Factors For Radiation Pneumonitis After Conventiomentioning

confidence: 99%

Comparison of clinical, tumour-related and dosimetric factors in grade 0–1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours

Takeda

Ohashi²,

Kunieda

et al. 2012

BJR

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“…The pulmonary parenchyma itself is the most important dose-limit for radiotherapy in tumors in the thoracic region 37 . The graduation of the dose, however, also leads to an excessive exposure of organs at higher risk, such as lung, heart, esophagus and spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the physical activity effects and measurement of pro-inflammatory cytokines in irradiated lungs in rats

Bianchi¹,

Ropelle

Katashima³

et al. 2012

Acta Cir. Bras.

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Brazil. Tutor, responsible for conception, design, intellectual and scientific content of the study, critical analysis, final approval of manuscript. VI Full Professor, Department of Surgery, UNICAMP, Campinas-SP, Brazil. Critical revision and analysis of data. ABSTRACT PURPOSE:To study if the pre-radiotherapy physical activity has radio-protective elements, by measuring the radio-induced activation of pro-inflammatory cytokines as interleukin-6 (il-6), transforming growth factor -b (tgf -b), tumor necrosis factor -a (tnf-a) and protein beta kinase b (ikkb), through western blotting analysis. METHODS:A randomized study with 28 Wistar hannover rats, males, with a mean age of 90 days and weighing about 200 grams. The animals were divided into three groups: (GI, GII and GIII). GIII group were submitted to swimming for eight weeks (zero load, three times a week, about 30 minutes). Then, the groups (except the control group) were submitted to irradiation by cobalt therapy, single dose of 3.5 gray in the whole body. All animals were sacrificed by overdose of pentobarbital, according to the time for analysis of cytokines, and then a fragment of the lower lobe of the right lung went to western blotting analysis. RESULTS:The cytokines IKK b, TNF-a and IL-6 induced by radiation in the lung were lower in the exercised animals. However, exercise did not alter the radiation-induced increase in tgf-b. CONCLUSION:The results show a lower response in relation to inflammatory cytokines in the group that practiced the exercise preradiotherapy, showing that exercise can protect tissues from tissue damage due to irradiation.Key words: Radiotherapy. Radiation Pneumonitis. Pulmonary Fibrosis. Physical Therapy Modalities. Rats. RESUMO OBJETIVO:Verificar se a radioterapia pré-atividade física tem elementos de rádio-proteção, medindo-se a ativação de citocinas pró-inflamatórias como a interleucina-6 (IL-6), fator transformador de crescimento -b (TGF -b), fator de necrose tumoral -a (TNF-a) e quinase de proteína beta b (IKK b), por meio da análise blotting ocidental. MÉTODOS:Um estudo randomizado empregando 28 ratos Wistar Hannover, machos, com idade média de 90 dias e pesando cerca de 200 gramas. Os animais foram divididos em três grupos: (GI, GII e GIII). Os animais do grupo GIII foram submetidos à natação durante oito semanas (carga zero, três vezes por semana, cerca de 30 minutos). Então, os grupos (exceto o grupo controle) foram submetidos à irradiação por cobalto terapia, dose única de 3,5 cinza em todo o corpo. Todos os animais foram sacrificados por overdose de pentobarbital, de acordo com o tempo de análise de citocinas, em seguida, um fragmento do lobo inferior do pulmão direito foi a Bianchi RCG et al. -Acta Cirúrgica Brasileira -Vol. 27 (3) 2012análise de mata-borrão ocidental. RESULTADOS:As citocinas IKK b, TNF-a e IL-6 induzidas por radiação no pulmão foram menores nos animais que se exercitaram.No entanto, o exercício não alterou o aumento induzido pela radiação na TGF-b. CONCLUSÃO:Os resultados mostraram uma menor respost...

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“…In treatment plan evaluation, these low dose parameters are not considered alone as critical while there are universally set values to ensure among all other lung criteria. Jin et al (57) studied MD Anderson Cancer Center data from 576 inoperable NSCLC patients to determine dose-volume thresholds for the risk of treatment-related pneumonitis after definitive radiotherapy. The incidence of grade 3 or more treatment-related pneumonitis was found to be only 2% if the following dose-volume parameters could be achieved: V5 ≤60%, V10 ≤42%, V20 ≤25%, V25 ≤20%, V35 ≤15%, and V50 ≤10%.…”

Section: Irradiation Of Large Volumes To Low Doses With Imrtmentioning

confidence: 99%

Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

Selek¹,

Bölükbaşı²,

Welsh³

et al. 2015

Balkan Med J

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In the evolution of radiation oncology technology, improved planning and treatment delivery advanced from two-dimensional radiotherapy (2DRT) to three-dimensional conformal radiotherapy (3DCRT) two decades ago. In the last decade, intensity-modulated radiation therapy (IMRT) emerged in addition to daily image guidance and fourdimensional (4D) image-based motion management (1). Chemoradiotherapy, which was actually established mainly with a 2DRT trial-RTOG 9410, is the current standard of care in patients with inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC) when compared to sequential protocols (2-7). Currently, aggressive chemoradiotherapy is the standard, and is well accepted in highly selected septuagenarians with inoperable stage IIIB NSCLC (8). Conventional doses (60-63 Gy) of 3DCRT were well-thought-out not enough to succeed for desired local control to avoid dismal survival. There has been a significant challenge in safely escalating the radiation dose over 60 Gy, while preserving the critical organ at risk (OAR) structures (9-12). In the last decade, IMRT has been the leading improvement, and has been considered as the key solution for safe dose escalation and delivery. Other accompanying challenges are the fight with unpredictable movement of the tumor during the respiratory phases, the need to increase the accuracy of treatment delivery during each fraction, and the necessity to clarify the heterogeneity correction in treatment planning systems. The newest technology has been improved upon in recent years by 4D image-based motion capturing and the management of treatment planning, the evolution of calculation algorithms in treatment planning systems that are capable of better estimating the dose delivery to tumors and normal structures, and image-guided radiotherapy. All of these improvements increased the daily setup accuracy. There is a requirement for radiotherapy is evident in NSCLC, with than 60% of these patients requiring radiotherapy during treatment, and more than 40% of patients who receive radiotherapy receive it during the initial treatment (13,14). Therefore, due to the growing struggle with lung cancer, the current debate, based on inclusion of all modern technology, is whether IMRT has an advantage over 3DCRT in the outcomes of local control, surChemoradiotherapy is the current standard of care in patients with advanced inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC). Three-dimensional radiotherapy (3DCRT) has been a trusted method for a long time and has well-known drawbacks, most of which could be improved by Intensity Modulated Radiotherapy (IMRT). IMRT is not currently the standard treatment of locally advanced NSCLC, but almost all patients could benefit to a degree in organ at risk sparing, dose coverage conformality, or dose escalation. The most critical step for a radiation oncology department is to strictly evaluate its own technical and physical capabilities to determine the ability of IMRT to deliver an optimal treatment plan.This includes calc...

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Dose–volume thresholds and smoking status for the risk of treatment-related pneumonitis in inoperable non-small cell lung cancer treated with definitive radiotherapy

Cited by 133 publications

References 29 publications

Comparison of clinical, tumour-related and dosimetric factors in grade 0–1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours

Comparison of clinical, tumour-related and dosimetric factors in grade 0–1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours

Analysis of the physical activity effects and measurement of pro-inflammatory cytokines in irradiated lungs in rats

Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

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