Background And Purpose: Radiation pneumonitis (RP) can be a potential fatal toxicity of stereotactic body radiation therapy (SBRT) for medically inoperable non-small cell lung cancer (NSCLC). This study aimed to examine the risk factors that predict RP and explore dosimetric tolerance for safe practice in a large institutional series of NSCLC patients.
Materials And Methods: Patients with early-stage and locally recurrent NSCLC who received lung SBRT between 2002 and 2015 formed the study population. The primary endpoint was grade 2 or above radiation pneumonitis (RP2). Lungs were re-contoured consistently by one radiation oncologist according to the RTOG atlas for organs at risk. Dosimetric factors were computed consistently with exclusion of gross tumor volume of either ipsilateral, contralateral, or total lungs.
Results: A total of 339 patients were eligible. With a median follow-up of 47 months, RP2 was recorded in 10% patients. History of respiratory comorbidity, previous thoracic radiation, right lung location, mean lung doses of total or ipsilateral lung, and total lung volume receiving 20 Gy were all significantly associated with the risk of RP2. The dosimetric parameters of contralateral lung, including mean dose and volume receiving more than 5, 10, and 20 Gy, were not significantly associated with RP2 (ps > 0.05). A model of combining significant clinical and dosimetric factors had a predictive accuracy AUC of 0.76. According to this model, RP2 can be limited to <10% should the patient have no previous lung radiation and the mean dose of total and ipsilateral lungs be kept less than 6 Gy and 20 Gy, respectively.
Conclusion: Dosimetric factors of total or ipsilateral lung together with important clinical factors were significant risk factors for symptomatic radiation pneumonitis after SBRT. Constraining mean lung dose can limit clinically significant lung toxicity.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.radonc.2020.10.015 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis.
Sao Paulo Med J
January 2025
Professor, Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil; Consultant, Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo (SP), Brazil.
Background: Radiation therapy (RT) is a standard treatment for non-metastatic breast cancer and is associated with acute and late toxicities. Intensity-modulated RT (IMRT) may decrease toxicity and is convenient for patients.
Objectives: To assess the efficacy and safety of IMRT in women with early stage breast cancer.
Combining radiotherapy with targeted therapy benefits patients with advanced epidermal growth factor receptor-mutated non-small cell lung cancer (EGFRm NSCLC). However, the optimal strategy to combine EGFR tyrosine kinase inhibitors (TKIs) with radiotherapy for maximum efficacy and minimal toxicity is still uncertain. Notably, EVs, which serve as communication mediators among tumor cells, play a crucial role in the anti-tumor immune response.
View Article and Find Full Text PDFMinimizing Long-Term Toxicities for Patients with Primary Mediastinal B-Cell Lymphoma Undergoing Modern Radiotherapy: Results from a Monocentric Biophysical Risk Evaluation.
Cancers (Basel)
December 2024
Department of Radiation Oncology, University Hospital of Münster, West German Cancer Center (WTZ), Network Partner Site, 48149 Münster, Germany.
Primary mediastinal B-cell lymphoma (PMBCL) is a rare form of aggressive B-cell lymphoma with a predominant onset in young patients. The minimization of potential (late) side effects is of cardinal interest for these patients. An anticipation of the individual risk profile is desirable to counsel the patient on the putative impact of radiotherapy (RT).
View Article and Find Full Text PDFOptimizing dosimetric accuracy in radioembolization: comparative effectiveness of SPECT/CT, planar imaging, and PET/CT for lung shunt fraction assessment.
Nucl Med Rev Cent East Eur
December 2024
Department of Radiology & Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care, and Research Center, Muscat, Oman.
Background: In radioembolization therapy for hepatic malignancies, the accurate estimation of lung shunt fraction (LSF) is crucial to minimize the risk of radiation-induced pneumonitis and fibrosis due to hepatopulmonary shunting of yttrium-90 (90Y)-microspheres. This study aimed to compare the accuracy and precision of LSF estimation using technetium-99m macroaggregated albumin single photon emission computed tomography ([99mTc]Tc-MAA SPECT) LSF, [99mTc]Tc-MAA planar LSF, and 90Y PET LSF in patients undergoing 90Y-radioembolization.
Material And Methods: A retrospective study was conducted involving 15 patients diagnosed with hepatocellular carcinoma (HCC) or liver metastases and planned to undergo transarterial radioembolization with 90Y SirSpheres after multidisplinary team discussion.
Nervonic acid alleviates radiation-induced early phase lung inflammation by targeting macrophages activation in mice.
Front Immunol
December 2024
Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan, China.
Background: Patients receiving chest radiation therapy, or exposed to high radiation levels due to accidental nuclear leakage are at risk of radiation-induced lung injury (RILI). In innate immunity, macrophages not only exhibit certain radiation tolerance but also play an important regulatory role in the whole pathological process. Nervonic acid (NA), a long-chain unsaturated fatty acid found in nerve tissue, plays a pivotal role in maintaining normal tissue growth and repair.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!