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

Murray, Louise; Karakaya, Ebru; Hinsley, Samantha; Naisbitt, Mitchell; Lilley, J.; Snee, M.; Clarke, K.; Musunuru, Hima Bindu; Ramasamy, S.; Turner, R.; Franks, K.

doi:10.1259/bjr.20150628

Cited by 16 publications

(12 citation statements)

References 30 publications

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“…In SBRT, the chest wall, ribs and vertebral bodies have become organs at risk, despite the fact that the majority of patients are asymptomatic or complain of mild toxicity. For chest wall pain, the risk increases when the D70cc is over 16 Gy in 4 fractions, and the D2cc above 43 Gy in 4 fractions [122,123]. The risk of symptomatic rib fractures after SBRT was significantly correlated to dose, and was <5% at 26 months when Dmax < 225 Gy (biologi-cal equivalent dose (BED), a/b = 3 Gy) [124,125].…”

Section: Fractionation For Stereotactic Body Radiotherapy (Sbrt)mentioning

confidence: 99%

European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer

Ruysscher

Faivre-Finn

Moeller

et al. 2017

Radiotherapy and Oncology

183

119

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Section: Fractionation For Stereotactic Body Radiotherapy (Sbrt)mentioning

confidence: 99%

European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer

Ruysscher

Faivre-Finn

Moeller

et al. 2017

Radiotherapy and Oncology

183

119

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“…9 Other studies have focused on D 2cc and D 70cc and these have been incorporated into international guidelines. 23,24,25 Another analysis on 476 patients found D max <225Gy to be correlated with lower risk of rib fractures.…”

Section: Dosimetric Factorsmentioning

confidence: 99%

Characterization of Chest Wall Toxicity During Long-term Follow Up After Thoracic Stereotactic Body Radiation Therapy

Chipko

Ojwang

Gharai

et al. 2019

Practical Radiation Oncology

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Purpose: Chest wall (CW) pain and rib fractures are frequently diagnosed following stereotactic body radiotherapy (SBRT) for malignant lung tumors. We hypothesize that multiple risk factors including bone mineral density (BMD) are associated with CW toxicity and that CW pain and rib fractures often evolve into chronic clinical problems. Methods: 118 lung tumors treated with SBRT in 100 patients with a minimum follow up of 2 years were retrospectively analyzed. The incidence, clinical course, and related demographic, clinical and dosimetric factors of CW pain and rib fractures were analyzed. In addition, BMD was assessed, and the radiographic appearance of radiation-induced rib fractures and their healing process was characterized. Results: Median follow up was 49 months (range 24-106). CW pain developed in 33/118 treatments (28%) after on average 12.5 months (0-50) and was more common in women (p=0.04). Mean duration of CW pain was 25 months (2-63), and 36% of patients never had resolution of CW pain. 34 of 118 (29%) treatments resulted in rib fractures at a mean time of 22 months (3-46) and were more common in women, African Americans, upper/middle lobe tumors, and patients with lower BMD (p<0.05). Mean duration of rib fractures was 25 months (5-41), and only 16 (47%) rib fractures healed. Shorter PTV-CW distance resulted in higher risk for both rib fractures and CW pain (p=0.01). 67% of fractures developed surrounding soft tissue fibrosis and 62% (21/34)

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“…Radiosurgery for lung cancer can deliver higher dose per treatment than conventional radiotherapy, thereby reducing the number of days required for treatment. The applications are increasing with the development of accurate treatment equipment such as a linear accelerator (LINAC) that has a high dose rate photon beam and micro multi-leaf collimator (MMLC) [ 1 – 3 ]. Especially, intensity modulated radiosurgery (IMRS) adopting the intensity modulated radiation therapy (IMRT) technique that minimizes the side effects of the organs at risk (OARs) surrounding the tumor target has been applied effectively to clinical lung cancer treatment [ 4 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Dose Distribution in Intensity Modulated Radiosurgery for Lung Cancer under Condition of Respiratory Motion

et al. 2016

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The dose of a real tumor target volume and surrounding organs at risk (OARs) under the effect of respiratory motion was calculated for a lung tumor plan, based on the target volume covering the whole tumor motion range for intensity modulated radiosurgery (IMRS). Two types of IMRS plans based on simulated respiratory motion were designed using humanoid and dynamic phantoms. Delivery quality assurance (DQA) was performed using ArcCHECK and MapCHECK2 for several moving conditions of the tumor and the real dose inside the humanoid phantom was evaluated using the 3DVH program. This evaluated dose in the tumor target and OAR using the 3DVH program was higher than the calculated dose in the plan, and a greater difference was seen for the RapidArc treatment than for the standard intensity modulated radiation therapy (IMRT) with fixed gantry angle beams. The results of this study show that for IMRS plans based on target volume, including the whole tumor motion range, tighter constraints of the OAR should be considered in the optimization process. The method devised in this study can be applied effectively to analyze the dose distribution in the real volume of tumor target and OARs in IMRT plans targeting the whole tumor motion range.

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

Cited by 16 publications

References 30 publications

European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer

European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer

Characterization of Chest Wall Toxicity During Long-term Follow Up After Thoracic Stereotactic Body Radiation Therapy

Evaluation of Dose Distribution in Intensity Modulated Radiosurgery for Lung Cancer under Condition of Respiratory Motion

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