Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy

Borst, Gerben R.; Ishikawa, Masayori; Nijkamp, Jasper; Hauptmann, Michael; Shirato, Hiroki; Onimaru, Rikiya; Heuvel, Michel M. van den; Belderbos, J.; Lebesque, Joos V.; Sonke, Jan‐Jakob

doi:10.1016/j.radonc.2009.02.003

Cited by 130 publications

(72 citation statements)

References 35 publications

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“…The larger PTV in this study results in a larger irradiated lung volume. Many studies have shown that the tolerance dose for the lungs depends on the irradiated lung volume and that the tolerance dose decreases as the irradiated volume increases [11,13,14], consistent with the results of our study here. Another explanation is the difference in the prior 15 distribution between the group with PTV < 100 cc and the group with PTV ≥ 100 cc.…”

Section: Discussionsupporting

confidence: 92%

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer (JCOG0702): Results for the group with PTV ⩾ 100 cc

Onimaru

Oda

Shibata

et al. 2017

Radiotherapy and Oncology

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Purpose: A dose escalation study to determine the recommended dose (RD) with stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinomas (NSCLC) was conducted. The results of the group with PTV ≥ 100 cc is reported in this paper. Materials and Methods:The continual reassessment method (CRM) was used to determine the dose level that patients should be assigned to and to estimate the maximum tolerated dose (MTD). Dose limiting toxicity (DLT) was Grade 3 or higher radiation pneumonitis (RP), and Grade 2 or higher RP was used as a surrogate DLT. The RD was equal to the MTD. The dose was prescribed at D 95 of the PTV.Results: Thirteen patients were accrued. More patients should have been enrolled but we decided not to prolong the study period. No patients experienced Grade 3 RP. Two patients experienced Grade 2 RP at 50 Gy in 4 fractions. The predicted MTD was 50.2Gy. The posterior probability of the Grade 2 RP frequency over 40% was 5.3% for the dose level of 50 Gy. The RD was determined to be 50 Gy.

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Section: Discussionsupporting

confidence: 92%

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer (JCOG0702): Results for the group with PTV ⩾ 100 cc

Onimaru

Oda

Shibata

et al. 2017

Radiotherapy and Oncology

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“…Therefore, the most important determinant of parallel functioning organ toxicity is the volume of the organ irradiated and its basal functional status (comorbidities). 41,[51][52][53] …”

Section: Radiosensitivity Of Late-responding Tissues and Organsmentioning

confidence: 99%

Radiobiology of stereotactic body radiation therapy (SBRT)

Garau

2017

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tRecent advances in the technology of radiotherapy have enabled the development of new therapeutic modalities that deliver radiation with very high accuracy, reduced margins and high dose conformation, allowing the reduction of healthy tissue irradiated and therefore minimizing the risk of toxicity. The next step was to increase the total tumor dose using conventional fractionation (which remains the best way to relatively radioprotect healthy tissues when large volumes are treated) or to use new fractionation schemes with greater biological effectiveness. Based on the experience gained in radiosurgery, the latter way was chosen for small and well-defined tumors in the body. Stereotactic body radiotherapy delivers high doses of radiation to small and well-defined targets in an extreme hypofractionated (and accelerated) scheme with a very high biological effectiveness obtaining very good initial clinical results in terms of local tumor control and acceptable rate of late complications.In fact, we realize a posteriori that it was not feasible to administer such biologically equivalent dose in a conventional fractionation because the treatment could last several months.So far, these new therapeutic modalities have been developed due to technologic advances in image guidance and treatment delivery but without a solid biological basis. It is the role of traditional radiobiology (and molecular radiobiology) to explain the effects of high doses of ionizing radiation on tumor and normal tissues. Only through a better understanding of how high doses of ionizing radiation act, clinicians will know exactly what we do, allowing us in the future to refine our treatments. This article attempts to describe through simple and understandable concepts the known aspects of the biological action of high doses of radiation on tumor and normal tissues, but it is clear that we need much more basic research to better understand the biology of high doses of radiation.

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“…9,36,[50][51][52][53]56,57,[59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] In terms of tumour dose, the LungTech protocol will investigate a medium hypofractionated approach, applying 8.0 3 7.5 Gy to a total dose of 60 Gy; this is equal to a BED of 105 Gy (a/b 5 10). Referring to report 83 of the International Commission on Radiation Units and Measurements (ICRU), 95% of the PTV has to receive at least the nominal fraction dose, and 99% of the PTV receives a minimum of 90% of the nominal dose.…”

Section: Prescribed Dose Normal Tissue Constraintsmentioning

confidence: 99%

LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective

Adebahr¹,

Collette²,

Shash³

et al. 2015

BJR

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Evidence supports stereotactic body radiotherapy (SBRT) as a curative treatment option for inoperable early stage nonsmall-cell lung cancer (NSCLC) resulting in high rates of tumour control and low risk of toxicity. However, promising results are mainly derived from SBRT of peripheral pulmonary lesions, whereas SBRT for the central tumours can lead to severe radiation sequelae owing to the spatial proximity to the serial organs at risk. Robust data on the tolerance of mediastinal structures to high-dose hypofractionated radiation are limited; furthermore, there are many open questions regarding the efficiency, safety and response assessment of SBRT in inoperable, centrally located early stage NSCLC, which are addressed in a prospective multicentre study [sponsored by the European Organization for Research and Treatment of Cancer (EORTC 22113-08113-LungTech)]. In this review, we summarize the current status regarding SBRT for centrally located early stage NSCLC that leads to the rationale of the LungTech trial. Outline and some essential features of the study with focus on a summary of current experiences in dose/fraction-toxicity coherences after SBRT to the mediastinal structures that lead to LungTech normal tissue constraints are provided.Stereotactic body radiotherapy (SBRT) is a technique in which high doses of radiotherapy are very precisely delivered with steep dose gradients and a short overall treatment time (OTT). This achieves a very high biological dose.1 Evidence supports SBRT as a curative treatment option for inoperable early stage non-small-cell-lung cancer (NSCLC).2-5 Highprecision, hypofractionated dose delivery enables a significant reduction in both target volume size and exposure of normal tissue (NT) to high doses, resulting in a decreased toxicity risk and high rates of local control.6-8 However, promising results are mainly derived from the SBRT of small peripheral pulmonary lesions with low risk of treatment-related toxicity, as these tumours are surrounded by parallel organs at risk (OARs), specifically lung tissue. In contrast, the SBRT for central tumours can lead to severe, potentially life-threatening radiation sequelae owing to the spatial proximity to serial OARs. As robust, prospective and multicentre data on the tolerance of mediastinal structures to high-dose hypofractionated radiation is limited, there is generally caution in implementing SBRT for central lung tumours. Current published data are rather inconsistent regarding the definition of "central tumour", SBRT techniques, dose prescription and reporting, calculation algorithms, image guidance and evaluation of outcome. A recent systematic review has summarized the current limited evidence on this topic, mainly from singlecentre experiences, 9 but there are still many open questions

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Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy

Cited by 130 publications

References 35 publications

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer (JCOG0702): Results for the group with PTV ⩾ 100 cc

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer (JCOG0702): Results for the group with PTV ⩾ 100 cc

Radiobiology of stereotactic body radiation therapy (SBRT)

LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective

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