Abstract
The risk factors for severe radiation pneumonitis (RP) in patients with lung cancer who undergo rotating gantry intensity-modulated radiation therapy (IMRT) using volumetric modulated arc therapy (VMAT) or helical tomotherapy (HT) are poorly understood. Fifty-two patients who received rotating gantry IMRT for locally advanced lung cancer were included in this retrospective study. In total, 31 and 21 patients received VMAT and HT, respectively. The median follow-up duration was 14 months (range, 5.2–33.6). Twenty (38%) and eight (15%) patients developed grade ≥ 2 and ≥ 3 RP, respectively. In multivariate analysis, lung V5 ≥ 40% was associated with grade ≥ 2 RP (P = 0.02), and past medical history of pneumonectomy and total lung volume ≤ 3260 cc were independently associated with grade ≥ 3 RP (P = 0.02 and P = 0.03, respectively). Rotating gantry IMRT was feasible and safe in patients with lung cancer undergoing definitive radiotherapy. Reducing lung V5 may decrease the risk of symptomatic RP, and care should be taken to avoid severe RP after radiotherapy in patients with a past medical history of pneumonectomy and small total lung volume.
Highlights
The risk factors for severe radiation pneumonitis (RP) in patients with lung cancer who undergo rotating gantry intensity-modulated radiation therapy (IMRT) using volumetric modulated arc therapy (VMAT) or helical tomotherapy (HT) are poorly understood
A large lowdose irradiated area such as V5 in the lung, which is often caused by IMRT, may be associated with symptomatic RP6,11
Multivariate analysis revealed that lung V5 ≥ 40% was associated with grade ≥ 2 RP, and a past medical history of pneumonectomy and a small total lung volume were independently associated with grade ≥ 3 RP
Summary
The risk factors for severe radiation pneumonitis (RP) in patients with lung cancer who undergo rotating gantry intensity-modulated radiation therapy (IMRT) using volumetric modulated arc therapy (VMAT) or helical tomotherapy (HT) are poorly understood. Reducing lung V5 may decrease the risk of symptomatic RP, and care should be taken to avoid severe RP after radiotherapy in patients with a past medical history of pneumonectomy and small total lung volume. The RTOG 0617 trial provided significant information for clinical practice, as it was the first large phase III NSCLC study to use intensity-modulated radiotherapy (IMRT) as a treatment modality for locally advanced NSCLC9. Volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) are modern forms of IMRT that are used in clinical practice Both techniques deliver a radiation beam via a linear accelerator that rotates around the patient and provides low-dose exposure to large volumes of the normal lung.
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