Incidence and Risk Factors for Chest Wall Toxicity After Risk-Adapted Stereotactic Radiotherapy for Early-Stage Lung Cancer

Abstract

Severe (grade 3) chest wall toxicity is uncommon after risk-adapted SABR and manifests in 2% or fewer of patients.

Lung stereotactic ablative radiotherapy (SABR): dosimetric considerations for chest wall toxicity

“…Bongers et al 25 in a study of 500 patients, demonstrated that larger treatment volumes and shorter tumour-to-chest wall distances were related to chest wall pain. Similarly, Stephans et al 10 concluded that tumour size correlated with late chest wall toxicity.…”

Exploratory analysis using machine learning to predict for chest wall pain in patients with stage I non‐small‐cell lung cancer treated with stereotactic body radiation therapy

“…All patients were planned with a constraint goal to keep 30 cc of the chest wall to <30.0 Gy. Twenty‐five parameters (termed features in the machine learning analysis) suspected of a correlation or previously reported10, 12, 13, 15, 17, 27, 28, 29, 30, 31 to associate with CWS were analyzed, including patient and tumor characteristics and dosimetric features were recorded for each patient. Toxicities were assessed using CTCAEv4 criteria for chest wall pain, where Grade 1 represents mild pain, Grade 2 represents moderate pain limiting instrumental activities of daily living (ADL), and Grade 3 represents severe pain limiting self‐care ADL.…”

“…The chest wall has been identified as an organ at risk for SBRT, with chest wall toxicities of any grade ranging from 2% to 45% following SBRT 9, 10, 11, 12. Radiation‐related chest wall toxicity can result from radiation‐induced rib fracture or chest wall syndrome (CWS).…”

Predictors and management of chest wall toxicity after lung stereotactic body radiotherapy

“…Theoretically, tumor distance from the chest wall should be the most significant predictor of toxicity. Multiple trials have demonstrated the impact of tumor distance with CWT [30,32,34]. Although [27].…”

“…If contour was outside of patient, it was brought into the external skin edge. Effort was made to include the thoracic nerve roots Dunlap [25] CW 3 cm expansion of lung minus lung volume, mediastinal soft tissue, vertebral body Kim [32] CW Ipsilateral hemibody that excluded the lungs and mediastinum Nambu [53] Ribs Contoured fractured ribs Stephans [27] CW Arc of all ipsilateral soft tissue outside of lung from edge of sternum circumferentially to the edge of the vertebral body including the spinal nerve root exit Taremi [30] Ribs Contoured ribs from the costovertebral to the costosternal/costal cartilage Welsh [37] CW Outer edge of patient's skin/chest wall automatically contoured minus total lung contour Bongers [34] CW Expansion of the lungs 2 cm in lateral, posterior, and anterior directions except in the direction of the mediastinum with inclusion of intercostal muscles but excluding other muscles and skin Woody [29] CW Contoured by expanding ipsilateral lung at least 3 cm in anterior, posterior, medial, lateral directions to cover relevant ribs and soft tissues and then adjusted to exclude spine, mediastinum, contralateral chest wall Mutter [28] CW 3 cm expansion of lung minus lung volume, mediastinal soft tissue, vertebral body Pettersson [31] Ribs Individual ribs receiving total dose of 21 Gy RTOG 1021/0915 Ribs Ribs within 5 cm of the PTV should be contoured by outlining the bone and marrow. Typically, several portions of adjacent ribs will be contoured as one structure.…”