Radiation Dose–Volume Effects in the Lung

Marks, Lawrence B.; Bentzen, Søren M.; Deasy, Joseph O.; Kong, Feng-Ming; Bradley, Jeffrey D.; Vogelius, I.R.; Naqa, Issam El; Hubbs, Jessica L.; Lebesque, Joos V.; Timmerman, Robert; Martel, Mary K.; Jackson, Andrew

doi:10.1016/j.ijrobp.2009.06.091

Cited by 919 publications

(706 citation statements)

References 67 publications

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“…Radiation-induced lung fibrosis (RILF) is a common delayed side effect of radiotherapy for thoracic malignancies, which limits the delivered dose to the tumor target and may thus hamper tumor control (1). RILF is believed to result from cytokine-mediated multicellular interactions with induction and progression of fibrotic tissue reactions (2,3); however, the mechanism(s) underlying the pathogenesis of RILF at the molecular and cellular levels has not yet been identified.…”

Section: Introductionmentioning

confidence: 99%

Th2-like immune response in radiation-induced lung fibrosis

Hân

Zhang²,

Xie

et al. 2011

Oncol Rep

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Section: Introductionmentioning

confidence: 99%

Th2-like immune response in radiation-induced lung fibrosis

Hân

Zhang²,

Xie

et al. 2011

Oncol Rep

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“…

…”

mentioning

confidence: 99%

CT ventilation functional image-based IMRT treatment plans are comparable to SPECT ventilation functional image-based plans

Kida

Bal

Kabus

et al. 2016

Radiotherapy and Oncology

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Radiation-induced lung injury has detrimental effects on lung function and is associated with radiation pneumonitis, which is a potentially fatal toxicity and occurs in up to 30% of lung cancer patients treated with radiotherapy [1,2]. Radiotherapy that selectively avoids irradiating highly-functional lung regions may reduce pulmonary toxicity [3][4][5]. This hypothesis is supported by several reports in the literature. Lung dose-function metrics were found to improve predictive power for pulmonary toxicity compared to dose-volume metrics [6,7]. The mean functional V 20 (fV 20 ) (percent lung function receiving P20 Gy) for patients who developed Grade P3 pneumonitis was 4.3% greater (p = 0.09) than those who did not, and it was closer to statistical significance than the V 20 (percent lung volume receiving P20 Gy) (p = 0.33) [7].Several modalities exist for pulmonary ventilation imaging [8][9][10][11]. Ventilation images can also be acquired by a method based on four-dimensional (4D) computed tomography (CT) and image processing/analysis [12,13], henceforth referred to as CT ventilation imaging. CT ventilation imaging has the potential for widespread clinical implementation, as 4D-CT is routinely acquired for treatment planning at many centers [14] and ventilation computation only involves image processing/analysis without extra scans to patients. Additionally, CT ventilation imaging has a shorter scan time, higher spatial resolution (the exact resolution is unknown), lower cost, and/or greater availability than other modalities.Validation studies for CT ventilation imaging have been focused on cross-modality image comparisons [15][16][17][18][19][20][21][22]. For example, studies with mechanically ventilated sheep have demonstrated strong correlations between CT ventilation and xenon-CT ventilation [15,16]. Human studies have also reported reasonable correlations with ventilation scintigraphy [21], single-photon emission CT (SPECT) ventilation [22] and other modalities [19,20]. Previously we have demonstrated that CT ventilation in SPECT ventilationdefined defect regions of interest (ROIs) is significantly lower than http://dx

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“…Some patients suffered from severe side effects after radiation therapy 6, 7. Radiation pneumonitis (RP) is the main dose‐limiting complication in radiation therapy for NSCLC, and occurs in 5%–50% of patients 8, 9. In the case of conventionally fractionated radiotherapy, the traditional strategy for minimizing patients' risk is to follow empirically established dose–volume constraints, such as V20 < 30%–35% and mean lung dose (MLD) <20–23 Gy.…”

Section: Introductionmentioning

confidence: 99%

Reducing dose to the lungs through loosing target dose homogeneity requirement for radiotherapy of non small cell lung cancer

Miao

Yan

Tian

et al. 2017

J Applied Clin Med Phys

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It is important to minimize lung dose during intensity‐modulated radiation therapy (IMRT) of nonsmall cell lung cancer (NSCLC). In this study, an approach was proposed to reduce lung dose by relaxing the constraint of target dose homogeneity during treatment planning of IMRT. Ten NSCLC patients with lung tumor on the right side were selected. The total dose for planning target volume (PTV) was 60 Gy (2 Gy/fraction). For each patient, two IMRT plans with six beams were created in Pinnacle treatment planning system. The dose homogeneity of target was controlled by constraints on the maximum and uniform doses of target volume. One IMRT plan was made with homogeneous target dose (the resulting target dose was within 95%–107% of the prescribed dose), while another IMRT plan was made with inhomogeneous target dose (the resulting target dose was more than 95% of the prescribed dose). During plan optimization, the dose of cord and heart in two types of IMRT plans were kept nearly the same. The doses of lungs, PTV and organs at risk (OARs) between two types of IMRT plans were compared and analyzed quantitatively. For all patients, the lung dose was decreased in the IMRT plans with inhomogeneous target dose. On average, the mean dose, V5, V20, and V30 of lung were reduced by 1.4 Gy, 4.8%, 3.7%, and 1.7%, respectively, and the dose to normal tissue was also reduced. These reductions in DVH values were all statistically significant (P < 0.05). There were no significant differences between the two IMRT plans on V25, V30, V40, V50 and mean dose for heart. The maximum doses of cords in two type IMRT plans were nearly the same. IMRT plans with inhomogeneous target dose could protect lungs better and may be considered as a choice for treating NSCLC.

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Radiation Dose–Volume Effects in the Lung

Abstract: The three dimensional dose/volume/outcome data for lung are reviewed in detail. The rate of symptomatic pneumonitis is related to many dosimetric parameters, and there are no evident threshold “tolerance dose/volume” levels. There are strong volume and fractionation effects.

Cited by 919 publications

References 67 publications

Th2-like immune response in radiation-induced lung fibrosis

Th2-like immune response in radiation-induced lung fibrosis

CT ventilation functional image-based IMRT treatment plans are comparable to SPECT ventilation functional image-based plans

Reducing dose to the lungs through loosing target dose homogeneity requirement for radiotherapy of non small cell lung cancer

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