Significance of low-dose radiation distribution in development of radiation pneumonitis after helical-tomotherapy-based hypofractionated radiotherapy for pulmonary metastases

Abstract

Hypofractionated radiotherapy (HRT) is now commonly used for pulmonary malignancies, since a tumoricidal dose can be accurately delivered to the target without a consequential dose to adjacent normal tissues. However, radiation pneumonitis (RP) is still a major problem after HRT. To determine the significant parameters associated with developing RP, we retrospectively investigated data from patients with lung metastases treated with HRT using helical tomotherapy. A total of 45 patients were included in the study and the median age was 53 years old. The median prescriptive doses were 50 Gy to the internal target volume and 40 Gy to the planning target volume in 10 fractions over 2 weeks. RP was diagnosed by chest X-ray or computed tomography after HRT, and its severity was determined by CTCAE version 4.0. The incidence of symptomatic RP was 26.6%. Univariate analysis indicated that mean lung doses, V5, V10, V15, V20 and V25 were associated with the development of symptomatic RP (P < 0.05). However, multivariate analysis indicated that only V5 was associated with the development of symptomatic RP (P = 0.019). From the ROC curve, V5 was the most powerful predictor of symptomatic RP, and its AUC (area under curve) was 0.780 (P = 0.004). In addition, the threshold value of V5 for the development of symptomatic RP was 65%. A large distribution of low-dose radiation resulted in a higher risk of lung toxicity. So, to prevent symptomatic RP, it is recommended that the V5 be limited to <65%, in addition to considering conventional dosimetric factors. However, further clinical study must be undertaken in order to confirm this result.

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

“…27,28 When analyzing the predictive factors potentially involved in the development of RP, we could find neither dosimetric nor clinical factors significantly associated with treatment-related toxicity. In contrast to some other series employing HT in either a conventional or a hypofractionated schedule for primary and metastatic lung tumours, where cutoff values for ipsilateral 29 and contralateral percentage of lung volume receiving 5 Gy 11,30 have been proposed, these findings confirm our previous experience with HHT on a limited cohort of patients with early-stage NSCLC. 31 Fourth, we provided a detailed radiological description of lung appearances after HHT and concluded that a specific pattern of lung injury was not associated with this technique.…”

Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

“…The reported lung doses are well below the suggested QUANTEC constraints [37] and the V5 constraint proposed by Jo et al to limit the risk of radiation pneumonitis [38]. We also note that the contralateral lung receives less dose in prone than in supine position.…”

Early Toxicity in Patients Treated With Postoperative Proton Therapy for Locally Advanced Breast Cancer

“…There is a similar risk pattern for radiation-induced pneumonitis. Although the data in breast cancer patients are limited (22), several authors have found low-dose lung parameters, including the volume receiving 10 Gy (V10) and 5 Gy (V5), to be significant predictors in patients treated for breast and lung cancer (23–25). …”