Estimation of pneumonitis risk in three-dimensional treatment planning using dose-volume histogram analysis

Oetzel, Dieter; Schraube, P.; Hensley, Frank W.; Sroka-Pérez, G.; Menke, Markus; Flentje, Michael

doi:10.1016/0360-3016(95)00009-n

Cited by 197 publications

(84 citation statements)

References 11 publications

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“…Besides this, a huge reduction of about 17 Á/18% on average was observed in the lung volume receiving very high dose levels (V 45Gy ); in a single case, this reduction reached a value of about 27%. Mean lung dose dropped by an average of about 4 Gy, below the tolerance threshold level of 15 Gy suggested by Oetzel (10). The behaviour can easily be appreciated in Fig.…”

Section: Dose Plans Analysismentioning

confidence: 73%

“…For safety, the threshold used as patient inclusion criterion in this study was derived from consolidated literature (10). Nevertheless the selection according to a mean ipsilateral lung dose expected with conventional treatment (2F) exceeding 15 Gy was associated with the capability to reduce this value to about 12 Gy with 3F.…”

Section: Discussionmentioning

confidence: 99%

“…A mean ipsilateral lung dose exceeding 15 Gy ( Â/30% of the prescribed dose of about 50 Gy) with the 2F plan was defined as the inclusion threshold. Below this value no radiation pneumonitis should be expected (10). In view of a departmental code of practice in force, as already mentioned, the contralateral breast should not be irradiated in its inner quadrant in order to avoid any undue risk of induced cancer (7,11,12), severe ipsilateral lung irradiation cannot be reduced with tangential techniques simply by changing the beam angles.…”

Section: Patient Selection Volume Definition and Treatment Objectivesmentioning

confidence: 99%

See 2 more Smart Citations

Breast irradiation with three conformal photon fields for patients with high lung involvement

Cozzi¹,

Fogliata²,

Nicolini³

et al. 2004

Acta Oncologica

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Section: Dose Plans Analysismentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Patient Selection Volume Definition and Treatment Objectivesmentioning

confidence: 99%

See 1 more Smart Citation

Breast irradiation with three conformal photon fields for patients with high lung involvement

Cozzi¹,

Fogliata²,

Nicolini³

et al. 2004

Acta Oncologica

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“…We and others have developed predictive models based primarily on dosimetric parameters such as the mean lung dose (MLD). Indeed, the rates of pneumonitis appear to increase with MLD in several, largely retrospective, trials [2][3][4][5][6]8]. Further, our data suggest that predictive models are improved if they consider both the three-dimensional (3D) dose distribution plus the pre-RT functional state [9].…”

Section: Introductionmentioning

confidence: 71%

“…Radiation (RT)-induced shortness of breath occurs in approximately 5-30% of patients receiving thoracic RT for lung cancer [1][2][3][4][5][6][7][8]. Despite the large number of patients receiving thoracic RT, there are currently no validated and standardized means of predicting an individual patient's the risk of developing pulmonary toxicity.…”

Section: Introductionmentioning

confidence: 99%

Prospective assessment of dosimetric/physiologic-based models for predicting radiation pneumonitis

Koçak

Borst

Zeng

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-Clinical and 3D dosimetric parameters are associated with symptomatic radiation pneumonitis rates in retrospective studies. Such parameters include: mean lung dose (MLD), radiation (RT) dose to perfused lung (via SPECT), and pre-RT lung function. Based on prior publications, we defined pre-RT criteria hypothesized to be predictive for later development of pneumonitis. We herein prospectively test the predictive abilities of these dosimetric/functional parameters on two cohorts of patients from Duke and the Netherlands Cancer Institute (NKI).Methods and Materials-For the Duke cohort, 55 eligible patients treated between 1999-2005 on a prospective IRB-approved study to monitor RT-induced lung injury were analyzed. A similar group of patients treated at the NKI between 1996-2002 were identified. Patients believed to be at high and low risk for pneumonitis were defined based on: a) MLD; b) OpRP (sum of predicted perfusion reduction based on regional dose response curve); and c) pre-RT DLCO. All doses reflected tissue density heterogeneity. The rates of grade ≥2 pneumonitis in the "presumed" high and low risk groups were compared using Fisher's exact test.Results-In the Duke group, pneumonitis rates in patients prospectively deemed to be at "high" vs. "low" risk are 7/20 and 9/35, respectively; p=0.33 one tailed Fisher's. Similarly, comparable rates for the NKI group are 4/21 and 6/44, respectively, p=0.41 one-tailed Fisher's. Conclusion-The prospective model is unable to accurately segregate patients into high vs. low risk groups. However, considered retrospectively, these data are consistent with prior studies suggesting that dosimetric (e.g. MLD) and functional (e.g. PFTs or SPECT) parameters are predictive Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errorsmaybe discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. for RT-induced pneumonitis. Additional work is needed to better identify, and prospectively assess, predictors of RT-induced lung injury. NIH Public Access

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Computed tomographic evaluation of radiation pneumonitis in a canine model

Forrest

Mahler

Vail

et al. 1998

Radiat. Oncol. Investig.

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The objective of this study was to document the utility of computed tomography (CT) and a three‐dimensional (3‐D) radiotherapy treatment planning system for assessing the development of acute radiation pneumonitis in a canine model. Fourteen dogs were randomly assigned to a nonirradiated control group or one of three radiation dose groups receiving a single fraction of either 12, 15, or 18 Gy delivered to two‐thirds of the right hemithorax. CT and survey radiographs were performed in all dogs prior to and at defined intervals for up to 13 weeks following irradiation. All images were subjectively evaluated for development of radiation pneumonitis and CT images were quantitatively analyzed. Radiation pneumonitis was detected earlier with CT images than with radiographs. Quantitatively, functional lung volume and radiation pneumonitis lesion volume on CT images changed over time in all irradiated dogs. However, there was no statistically significant difference between the three radiation dose groups, but a marked difference between irradiated dogs and nonirradiated controls. These data suggest that CT is superior to survey radiography for the evaluation and quantification of acute radiation pneumonitis in this canine model. Quantification of acute radiation pneumonitis suggests future promise for evaluating the efficacy of modifiers to lessen the effects of irradiating normal lung tissue in this canine model. Radiat. Oncol. Invest. 6:128–134, 1998. © 1998 Wiley‐Liss, Inc.

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Estimation of pneumonitis risk in three-dimensional treatment planning using dose-volume histogram analysis

Cited by 197 publications

References 11 publications

Breast irradiation with three conformal photon fields for patients with high lung involvement

Breast irradiation with three conformal photon fields for patients with high lung involvement

Prospective assessment of dosimetric/physiologic-based models for predicting radiation pneumonitis

Computed tomographic evaluation of radiation pneumonitis in a canine model

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