Impact of Fractionation and Dose in a Multivariate Model for Radiation-Induced Chest Wall Pain

Din, S.U.; Williams, Eric; Jackson, Andrew; Rosenzweig, Kenneth E.; Wu, Abraham J.; Foster, Amanda; Yorke, Ellen; Rimner, Andreas

doi:10.1016/j.ijrobp.2015.06.014

Cited by 20 publications

(10 citation statements)

References 26 publications

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“…Likewise, this study found toxicity in the same proportions as previous reports: 31% clinically symptomatic RP [about 10-20% of patients in literature (range: 0-49% among published studies)] with most patients having asymptomatic Grade 1 pneumonitis (2,(15)(16)(17), 14% G1 chest wall pain [10-40% in literature (32)], 7% transient G ≤ 2 radiation dermatitis [12-38% in literature (33)], and 4% rib fractures [0-23% in literature (34)] without other toxicity. No significant predictive factor of chest wall pain, radiation dermatitis or rib fractures was found, probably due to meeting dose constraints (35).…”

Section: Discussionsupporting

confidence: 89%

Significant Correlation Between Overall Survival and Mean Lung Dose in Lung Stereotactic Body Radiation Therapy (SBRT)

et al. 2020

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Background: After stereotactic body radiation therapy (SBRT) for medically inoperable stage I non-small-cell lung cancer (NSCLC), more patients die of comorbidities, particularly severe pulmonary insufficiency, than of tumor progression. The aim of this study was to evaluate correlation between lung biologically effective dose (BED) with an α/β ratio of 3 Gy (BED 3) and overall survival (OS) for these patients. Methods: From 2012 to 2017, we have developed a prospectively updated institutional database for all first 100 consecutively treated patients with inoperable Stage 1 (T1T2N0M0) NSCLC. All SBRT were conducted on a Novalis Tx R LINAC with two coplanar dynamic conformal arcs (84%) or with coplanar volumetric modulated arc therapy (VMAT) (16%). Mean GTV and PTV were 8.6 cc and 50.8 cc, respectively. The marginal dose prescribed to the PTV was the 80% isodose line (IDL), i.e., 54 Gy in 3 fractions for 76 patients (BED 10 = 126 Gy) and 50 Gy in 5 fractions for 24 patients (BED 10 = 83.3 Gy). Pulmonary heterogeneity has been taken into account by using Monte Carlo or AAA algorithms. Median follow-up was 25 months. Results: At 1, 2, 3 and 5 years, local control (LC) was respectively 100, 98.2, 98.2, and 77.7%, and OS was respectively 83, 71.2, 58.1, and 33.2% (median OS was 49 months). Significant OS prognostic factors in univariate and multivariate analysis were mean lung BED 3 (HR = 1.14, p = 0.01) and PTV volume (HR = 1.01, p = 0.004). A mean lung BED 3 ≤ 5 Gy was significantly associated with a doubling of median OS from 29 months to more than 60 months (not achieved, p = 0.0068). For patients with a forced expiratory volume in 1 second (FEV1) ≤ 40%, a mean lung BED 3 ≤ 4 Gy was significantly associated with a doubling of median OS from 23 to 46 months (p = 0.019). Conclusion: Mean lung BED 3 is strongly and significantly associated with OS in SBRT for inoperable Stage I NSCLC. For all treated patients, a mean lung BED 3 ≤ 5 Gy lead to a doubling of median OS. This threshold value should be reduced to 4 Gy for patients with FEV1 ≤ 40%.

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Section: Discussionsupporting

confidence: 89%

Significant Correlation Between Overall Survival and Mean Lung Dose in Lung Stereotactic Body Radiation Therapy (SBRT)

et al. 2020

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“…Some studies reported that a short distance from the rib and chest wall to the tumor (<1.0–2.0 cm) increases the of risk of RIRFs [ 12 – 14 ]. However, in the evaluation of risk of RIRF, the use of rib–tumor distance as a risk factor is not appropriate because the dose to the ribs and chest wall can be decreased by use of intensity-modulated radiation therapy (IMRT) techniques, including VMAT.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported that the incidence of RIRF after SBRT for lung tumors was 23–37% [ 9 – 12 ]. Clinical factors such as target location [ 9 ], female sex [ 10 , 13 ] and rib–tumor distance [ 12 – 14 ] are known to increase the risk of RIRF and chest wall pain after SBRT for lung tumors. Regarding dosimetric factors, a high-dose-irradiated volume of the chest wall is thought to contribute to the increased the incidence of such adverse events [ 7 , 8 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Possibility of chest wall dose reduction using volumetric-modulated arc therapy (VMAT) in radiation-induced rib fracture cases: comparison with stereotactic body radiation therapy (SBRT)

Murakami

Nakano

Yoshida

et al. 2018

Journal of Radiation Research

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The present study compares dosimetric parameters between volumetric-modulated arc therapy (VMAT) and 3D conformal radiation therapy (3D-CRT) in lung tumors adjacent to the chest wall treated with stereotactic body radiation therapy (SBRT). The study focused on the radiation dose to the chest wall of 16 patients who had developed radiation-induced rib fractures (RIRF) after SBRT using 3D-CRT. The targets in all patients were partially overlapping with the fractured ribs, and the median overlapping rib–PTV distance was 0.4 cm. Stereotactic body radiation therapy was re-planned for all patients. The prescribed dose was 48 Gy in four fractions to cover at least 95% of the planning target volume (PTV). Evaluated dosimetric factors included D98% and the conformation number (CN) of the PTV, the D2cm3, V40 and V30 of the fractured ribs, the V30 of the chest wall, and the Dmean, V20 and V5 of the lung. A comparison of 3D-CRT with the VMAT plan for PTV revealed that CN was significantly improved in the VMAT plan, whereas D98% did not significantly differ between the two plans. Regarding organs at risk (OARs), the D2cm3, V40 and V30 of fractured ribs, the V30 of the chest wall, and the Dmean, V20 and V5 of the lung, were significantly decreased in the VMAT plan. We concluded that the dose to OARs such as ribs and chest wall could be reduced with improved target conformity using VMAT instead of 3D-CRT for SBRT to treat peripheral lung tumors.

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“… 14 An additional chest wall dose constraint was applied on the basis of Memorial Sloan Kettering data evaluating the risk of chest wall toxicity in patients treated with 5-fraction stereotactic body radiation therapy for early stage non-small cell lung cancer. 18 …”

Section: Methodsmentioning

confidence: 99%

Definitive hypofractionated radiation therapy for early stage breast cancer: Dosimetric feasibility of stereotactic ablative radiotherapy and proton beam therapy for intact breast tumors

Lischalk

Chen

Repka

et al. 2018

Advances in Radiation Oncology

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PurposeFew definitive treatment options exist for elderly patients diagnosed with early stage breast cancer who are medically inoperable or refuse surgery. Historical data suggest very poor local control with hormone therapy alone. We examined the dosimetric feasibility of hypofractionated radiation therapy using stereotactic ablative radiotherapy (SABR) and proton beam therapy (PBT) as a means of definitive treatment for early stage breast cancer.Methods and MaterialsFifteen patients with biopsy-proven early stage breast cancer with a clinically visible tumor on preoperative computed tomography scans were identified. Gross tumor volumes were contoured and correlated with known biopsy-proven malignancy on prior imaging. Treatment margins were created on the basis of set-up uncertainty and image guidance capabilities of the three radiation modalities analyzed (3-dimensional conformal radiation therapy [3D-CRT], SABR, and PBT) to deliver a total dose of 50 Gy in 5 fractions. Dose volume histograms were analyzed and compared between treatment techniques.ResultsThe median planning target volume (PTV) for SABR, PBT, and 3-dimensional CRT was 11.91, 21.03, and 45.08 cm3, respectively, and were significantly different (P < .0001) between treatment modalities. Overall target coverage of gross tumor and clinical target volumes was excellent with all three modalities. Both SABR and PBT demonstrated significant dosimetric improvements, each in its own unique manner, relative to 3D-CRT. Dose constraints to normal structures including ipsilateral/contralateral breast, bilateral lungs, and heart were all consistently achieved using SABR and PBT. However, skin or chest wall dose constraints were exceeded in some cases for both SABR and PBT plans and was dictated by the anatomic location of the tumor.ConclusionsDefinitive hypofractionated radiation therapy using SABR and PBT appears to be dosimetrically feasible for the treatment of early stage breast cancer. The anatomical location of the tumor relative to the skin and chest wall appears to be the primary limiting dosimetric factor.

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Impact of Fractionation and Dose in a Multivariate Model for Radiation-Induced Chest Wall Pain

Cited by 20 publications

References 26 publications

Significant Correlation Between Overall Survival and Mean Lung Dose in Lung Stereotactic Body Radiation Therapy (SBRT)

Significant Correlation Between Overall Survival and Mean Lung Dose in Lung Stereotactic Body Radiation Therapy (SBRT)

Possibility of chest wall dose reduction using volumetric-modulated arc therapy (VMAT) in radiation-induced rib fracture cases: comparison with stereotactic body radiation therapy (SBRT)

Definitive hypofractionated radiation therapy for early stage breast cancer: Dosimetric feasibility of stereotactic ablative radiotherapy and proton beam therapy for intact breast tumors

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