Lung Size and the Risk of Radiation Pneumonitis

Briere, Tina Marie; Krafft, Shane P.; Liao, Zhongxing; Martel, Mary K.

doi:10.1016/j.ijrobp.2015.10.002

Cited by 31 publications

(24 citation statements)

References 25 publications

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“…Both studies demonstrate that RP occurs if significant sub-volumes are damaged. This conclusion is further validated by the study reported in (3), which found RP incidence significantly increases if the sparing lung volume (dose ≤ 40Gy) is less than 1852cc.…”

Section: Discussionsupporting

confidence: 77%

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Dosiomics: Extracting 3D Spatial Features From Dose Distribution to Predict Incidence of Radiation Pneumonitis

et al. 2019

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Radiation pneumonitis (RP) is one of the major toxicities of thoracic radiation therapy. RP incidence has been proven to be closely associated with the dosimetric factors and normal tissue control possibility (NTCP) factors. However, because these factors only utilize limited information of the dose distribution, the prediction abilities of these factors are modest. We adopted the dosiomics method for RP prediction. The dosiomics method first extracts spatial features of the dose distribution within ipsilateral, contralateral, and total lungs, and then uses these extracted features to construct prediction model via univariate and multivariate logistic regression (LR). The dosiomics method is validated using 70 non-small cell lung cancer (NSCLC) patients treated with volumetric modulated arc therapy (VMAT) radiotherapy. Dosimetric and NTCP factors based prediction models are also constructed to compare with the dosiomics features based prediction model. For the dosimetric, NTCP and dosiomics factors/features, the most significant single factors/features are the mean dose, parallel/serial (PS) NTCP and gray level co-occurrence matrix (GLCM) contrast of ipsilateral lung, respectively. And the area under curve (AUC) of univariate LR is 0.665, 0.710 and 0.709, respectively. The second significant factors are V 5 of contralateral lung, equivalent uniform dose (EUD) derived from PS NTCP of contralateral lung and the low gray level run emphasis of gray level run length matrix (GLRLM) of total lungs. The AUC of multivariate LR is improved to 0.676, 0.744, and 0.782, respectively. The results demonstrate that the univariate LR of dosiomics features has approximate predictive ability with NTCP factors, and the multivariate LR outperforms both the dosimetric and NTCP factors. In conclusion, the spatial features of dose distribution extracted by the dosiomics method effectively improves the prediction ability.

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Section: Discussionsupporting

confidence: 77%

“…Ramella et al found that RP incidence is associated with V 20 and V 30 (2). Briere et al reported that RP incidence significantly increases if the sparing lung volume is <1852cc (receiving dose≤40Gy) (3). Pinnix et al reported that V 5 has better prediction capability than V 10 , V 15 , and V 20 (4).…”

Section: Introductionmentioning

confidence: 99%

Dosiomics: Extracting 3D Spatial Features From Dose Distribution to Predict Incidence of Radiation Pneumonitis

et al. 2019

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“…A small number of clinical studies has addressed potential differences in the sensitivity to develop normal tissue radiation injury between male and female patients, including in the cardiopulmonary system [162][163][164][165]. Interestingly, as also described for preclinical animal models, an increased pulmonary radiation toxicity in women compared to men may be at least in part related to a smaller total lung volume in women and therefore a relatively larger percent volume of the female lung exposed to radiation [166,167]. The vast majority of preclinical studies of RIHD have used either male or female animals, and only few studies have included both sexes (examples include [49,168]).…”

Section: Preclinical Models To Study Cardiac Radiation Toxicities: Anmentioning

confidence: 99%

Advances in Preclinical Research Models of Radiation-Induced Cardiac Toxicity

Schlaak

SenthilKumar

Boerma

et al. 2020

Cancers

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Radiation therapy (RT) is an important component of cancer therapy, with >50% of cancer patients receiving RT. As the number of cancer survivors increases, the short-and long-term side effects of cancer therapy are of growing concern. Side effects of RT for thoracic tumors, notably cardiac and pulmonary toxicities, can cause morbidity and mortality in long-term cancer survivors. An understanding of the biological pathways and mechanisms involved in normal tissue toxicity from RT will improve future cancer treatments by reducing the risk of long-term side effects. Many of these mechanistic studies are performed in animal models of radiation exposure. In this area of research, the use of small animal image-guided RT with treatment planning systems that allow more accurate dose determination has the potential to revolutionize knowledge of clinically relevant tumor and normal tissue radiobiology. However, there are still a number of challenges to overcome to optimize such radiation delivery, including dose verification and calibration, determination of doses received by adjacent normal tissues that can affect outcomes, and motion management and identifying variation in doses due to animal heterogeneity. In addition, recent studies have begun to determine how animal strain and sex affect normal tissue radiation injuries. This review article discusses the known and potential benefits and caveats of newer technologies and methods used for small animal radiation delivery, as well as how the choice of animal models, including variables such as species, strain, and age, can alter the severity of cardiac radiation toxicities and impact their clinical relevance.

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“…Brierie et al who showed that RP depends on sparing of total lung volumes at 40 Gy resulted in a significantly decreased incidence of RP 6 months after radiotherapy in a cohort of 579 NSCLC patients of which 449 (77.5%) had concurrent chemotherapy and a radiotherapy dose of at least 50 Gy [ 18 ]. Their results and our findings in the present analysis suggest that in patients with locally advanced NSCLC (UICC stage III) receiving CRT, the radiation oncologist should monitor the dose volume of the healthy lung tissue receiving 40 Gy and above because this is likely to have an impact on both the incidence and the volumetric expansion of symptomatic RP, and sparing the lung treatment with >40 Gy (V40) might be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Temporal and spatial dose distribution of radiation pneumonitis after concurrent radiochemotherapy in stage III non-small cell cancer patients

et al. 2017

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Background and purposeRadiation pneumonitis (RP) is the most common subacute side effect after concurrent chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer. Several clinical and dose-volume (DV) parameters are associated with a distinct risk of symptomatic RP. The aim of this study was to assess the spatial dose distribution of the RP volume from first occurence to maximum volume expansion of RP.Material and methodsBetween 2007 and 2015, 732 patients with lung cancer were treated in an institution. Thirty-three patients met the following inclusion criteria: an RP grade II after CRT and a radiation dose ≥60 Gy and no prior medical history of cardiopulmonary comorbidities. The images of the first chest computed tomography (CT) confirming the diagnosis of RP and the CT images showing the maximum expansion of RP were merged with the treatment plan. The RP volume was delineated within the treatment plan, and a DV analysis was performed to evaluate the lung dose volume areas in which the RP manifested over time and whether dose volume changes within the RP volume occurred.ResultsA change from clinical diagnosis to maximum expansion of RP was observed as the RP at clinical appearance mainly manifested in the lower dose areas of the lung, whereas the RP volume at maximum expansion manifested in the higher dose areas, resulting in a significant shift of the assessed relative mean dose volume proportions within the RP volume. The mean relative dose volume proportion 0- ≤ 20 Gy decreased from 30.2% (range, 0–100) to 21.9% (range, 0–100; p = 0.04) at the expense of the dose volume > 40 Gy which increased from 39.2% (range, 0–100) to 49.8% (range, 0–100; p = 0.02), whereas the dose relative volume proportion > 20- ≤ 40 Gy showed no relevant change and slightly decreased from 30.6% (range, 0–85.7) to 28.3%, (range, 0–85.7; p = 0.34).ConclusionWe observed a considerable increase in the relative dose proportions within the RP volume from diagnosis to maximum volume extent from low dose zones below 20 Gy to zones above 40 Gy. Although the clinical impact on RP remains unknown, a reduction of healthy healthy lung tissue receiving >40 Gy (V40) might be an additional parameter for irradiation planning in lung cancer patients.

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Lung Size and the Risk of Radiation Pneumonitis

Cited by 31 publications

References 25 publications

Dosiomics: Extracting 3D Spatial Features From Dose Distribution to Predict Incidence of Radiation Pneumonitis

Dosiomics: Extracting 3D Spatial Features From Dose Distribution to Predict Incidence of Radiation Pneumonitis

Advances in Preclinical Research Models of Radiation-Induced Cardiac Toxicity

Temporal and spatial dose distribution of radiation pneumonitis after concurrent radiochemotherapy in stage III non-small cell cancer patients

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