Abstract
PurposeTo examine the frequency and potential of dose-volume predictors for chest wall (CW) toxicity (pain and/or rib fracture) for patients receiving lung stereotactic body radiotherapy (SBRT) using treatment planning methods to minimize CW dose and a risk-adapted fractionation scheme.MethodsWe reviewed data from 72 treatment plans, from 69 lung SBRT patients with at least one year of follow-up or CW toxicity, who were treated at our center between 2010 and 2013. Treatment plans were optimized to reduce CW dose and patients received a risk-adapted fractionation of 18 Gy×3 fractions (54 Gy total) if the CW V30 was less than 30 mL or 10–12 Gy×5 fractions (50–60 Gy total) otherwise. The association between CW toxicity and patient characteristics, treatment parameters and dose metrics, including biologically equivalent dose, were analyzed using logistic regression.ResultsWith a median follow-up of 20 months, 6 (8.3%) patients developed CW pain including three (4.2%) grade 1, two (2.8%) grade 2 and one (1.4%) grade 3. Five (6.9%) patients developed rib fractures, one of which was symptomatic. No significant associations between CW toxicity and patient and dosimetric variables were identified on univariate nor multivariate analysis.ConclusionsOptimization of treatment plans to reduce CW dose and a risk-adapted fractionation strategy of three or five fractions based on the CW V30 resulted in a low incidence of CW toxicity. Under these conditions, none of the patient characteristics or dose metrics we examined appeared to be predictive of CW pain.
Highlights
Stereotactic body radiation therapy (SBRT) has emerged as an excellent alternative to surgical resection for patients with medically inoperable early stage non-small cell lung cancer (NSCLC) or oligometastatic lesions to the lung
SBRT is a treatment technique that delivers highly conformal, high dose radiation, with a hypofractionated scheme (e.g. 18 Gray63 fractions), which is drastically different from conventionally fractionated radiation therapy (RT) which employs daily doses of,2 Gray per fraction delivered over several weeks
Woody et al [9] employed the concept of modified equivalent dose [17] and concluded for their series, that mEUD was a better predictor of chest wall (CW) pain than V30
Summary
We reviewed data from 72 treatment plans, from 69 lung SBRT patients with at least one year of follow-up or CW toxicity, who were treated at our center between 2010 and 2013. Treatment plans were optimized to reduce CW dose and patients received a risk-adapted fractionation of 18 Gy63 fractions (54 Gy total) if the CW V30 was less than 30 mL or 10– 12 Gy65 fractions (50–60 Gy total) otherwise. The association between CW toxicity and patient characteristics, treatment parameters and dose metrics, including biologically equivalent dose, were analyzed using logistic regression
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