Radiation-Induced Dyspnea in Lung Cancer Patients Treated with Stereotactic Body Radiation Therapy

Abstract

In this study, we investigated the prognostic factors for radiation-induced dyspnea after hypo-fractionated radiation therapy (RT) in 106 patients treated with Stereotactic Body RT for Non-Small-Cell Lung Cancer (NSCLC). The median prescription dose was 50 Gy (range: 40–54 Gy), delivered in a median of four fractions (range: 3–12). Dyspnea within six months after SBRT was scored according to CTCAE v.4.0. Biologically Effective Dose (α/β = 3 Gy) volume histograms for lungs and heart were extracted. Dosimetric parameters along with patient-specific and treatment-related factors were analyzed, multivariable logistic regression method with Leave-One-Out (LOO) internal validation applied. Model performance was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC) and calibration plot parameters. Fifty-seven patients (53.8%) out of 106 developed dyspnea of any grade after SBRT (25/57 grade ≥ 2 cases). A three-variable predictive model including patient comorbidity (COPD), heart volume and the relative lungs volume receiving more than 15 Gy was selected. The model displays an encouraging performance given by a training ROC-AUC = 0.71 [95%CI 0.61–0.80] and a LOO-ROC-AUC = 0.64 [95%CI 0.53–0.74]. Further modeling efforts are needed for dyspnea prediction in hypo-fractionated treatments in order to identify patients at high risk for developing lung toxicity more accurately.

Prospective study investigating hypofractionated proton beam therapy in patients with inoperable early stage non-small cell lung cancer

“…Patients who undergo hypofractionated RT frequently exhibit either temporary or permanently reduced lung function ( 24 ). In addition, dyspnea worsening due to radiation pneumonitis, which often occurs between 3 and 6 months post-treatment, was reported to have a broad range of 17%–66% ( 25 ). PBT is expected to have fewer side effects, owing to its ability to limit the radiation dose to the lungs.…”

Radiation-Induced Esophagitis in Non-Small-Cell Lung Cancer Patients: Voxel-Based Analysis and NTCP Modeling

“…In order to evaluate the impact of non-dosimetric and dosimetric factors on RE, the multivariable stepwise logistic regression method for NTCP modeling was applied [ 37 ]. The following dose metrics were extracted from DVHs for modeling: the relative volume receiving at least x dose (V x ) in steps of 5 Gy, the near maximum dose (D 2% ) and the mean dose (D mean ).…”

Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues

“…Thoracic RT is often associated with the risk of developing acute or late radiation-induced morbidities for which robust toxicity prediction models are required [ 16 ]. In [ 17 ], the prognostic factors for radiation-induced dyspnea after SBRT for NSCLC were investigated, and a logistic predictive model including clinical and dosimetric variables was proposed.…”