Chest Wall Toxicity After Stereotactic Body Radiotherapy for Malignant Lesions of the Lung and Liver

Andolino, David L.; Forquer, Jeffrey A.; Henderson, M.; Barriger, R. Bryan; Shapiro, Rachel; Brabham, Jeffrey G.; Johnstone, Peter A.S.; Cárdenes, Higinia R.; Fakiris, Achilles J.

doi:10.1016/j.ijrobp.2010.03.020

Cited by 98 publications

(79 citation statements)

References 18 publications

(23 reference statements)

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“…In our study, grade 2 RFs occurred in 12 patients following PBT (19.4%), with a three-year cumulative incidence rate of 30.2%. With regard to SRT, several groups reported RFs frequencies ranging from 4% to 37.7% after SRT for earlystage NSCLC; these rates were not much higher compared with those observed in our study (30.2%) (Pettersson et al 2009;Dunlap et al 2010;Andolino et al 2011;Welsh et al 2011;Asai et al 2012;Creach et al 2012;Mutter et al 2012;Stephans et al 2012;Taremi et al 2012;Nambu et al 2013). Although PBT reportedly offers advantages over SRT, it has not been reported to dramatically reduce RFs incidence (Georg et al 2008;Kadoya et al 2011).…”

Section: Discussioncontrasting

confidence: 71%

“…However, desired dose applications within target volumes are limited because of the proximity to critical normal tissues. Also, the incidence of rib fractures (RFs) following SRT for early-stage lung cancer ranges from 4% to 37.7% (Pettersson et al 2009;Dunlap et al 2010;Andolino et al 2011;Welsh et al 2011;Asai et al 2012;Creach et al 2012;Mutter et al 2012;Stephans et al 2012;Taremi et al 2012;Nambu et al 2013).…”

Section: Introductionmentioning

confidence: 99%

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Dosemetric Parameters Predictive of Rib Fractures after Proton Beam Therapy for Early-Stage Lung Cancer

Ishikawa

Nakamura

Katō

et al. 2016

Tohoku J. Exp. Med.

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Proton beam therapy (PBT) is the preferred modality for early-stage lung cancer. Compared with X-ray therapy, PBT offers good dose concentration as revealed by the characteristics of the Bragg peak. Rib fractures (RFs) after PBT lead to decreased quality of life for patients. However, the incidence of and the risk factors for RFs after PBT have not yet been clarified. We therefore explored the relationship between irradiated rib volume and RFs after PBT for early-stage lung cancer. The purpose of this study was to investigate the incidence and the risk factors for RFs following PBT for early-stage lung cancer. We investigated 52 early-stage lung cancer patients and analyzed a total of 215 irradiated ribs after PBT. Grade 2 RFs occurred in 12 patients (20 ribs); these RFs were symptomatic without displacement. No patient experienced more severe RFs. The median time to grade 2 RFs development was 17 months (range: 9-29 months). The three-year incidence of grade 2 RFs was 30.2%. According to the analysis comparing radiation dose and rib volume using receiver operating characteristic curves, we demonstrated that the volume of ribs receiving more than 120 Gy 3 (relative biological effectiveness (RBE)) was more than 3.7 cm 3 at an area under the curve of 0.81, which increased the incidence of RFs after PBT (P < 0.001). In this study, RFs were frequently observed following PBT for early-stage lung cancer. We demonstrated that the volume of ribs receiving more than 120 Gy 3 (RBE) was the most significant parameter for predicting RFs.

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Section: Discussioncontrasting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Dosemetric Parameters Predictive of Rib Fractures after Proton Beam Therapy for Early-Stage Lung Cancer

Ishikawa

Nakamura

Katō

et al. 2016

Tohoku J. Exp. Med.

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“…However, this does not imply that rib and chest wall doses can be simply disregarded since (a) CWS can result without the clinical appearance of rib fractures and (b) increasing risk may still occur with increasing dose in a continuous fashion 18. Other prior studies have examined factors including rib Dmax, rib dose to 0.5 cc, 2 cc, rib V30, V40, chest wall Dmax, chest wall dose to 8 cc, and chest wall V30, without clear indication of the relative superiority or inferiority of one of these dosimetric factors relative to the others 9, 13, 27, 29, 38, 39. Global Dmax and fraction size are also suggested to be important indicators of toxicity, with higher rates of radiation‐induced rib fracture of ~50% for DMax > 54 Gy and fraction size >8 Gy 16.…”

Section: Discussionmentioning

confidence: 99%

“…The chest wall has been identified as an organ at risk for SBRT, with chest wall toxicities of any grade ranging from 2% to 45% following SBRT 9, 10, 11, 12. Radiation‐related chest wall toxicity can result from radiation‐induced rib fracture or chest wall syndrome (CWS).…”

Section: Introductionmentioning

confidence: 99%

Exploratory analysis using machine learning to predict for chest wall pain in patients with stage I non‐small‐cell lung cancer treated with stereotactic body radiation therapy

Chao

Valdés

Luna

et al. 2018

J Applied Clin Med Phys

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Background and purposeChest wall toxicity is observed after stereotactic body radiation therapy (SBRT) for peripherally located lung tumors. We utilize machine learning algorithms to identify toxicity predictors to develop dose–volume constraints.Materials and methodsTwenty‐five patient, tumor, and dosimetric features were recorded for 197 consecutive patients with Stage I NSCLC treated with SBRT, 11 of whom (5.6%) developed CTCAEv4 grade ≥2 chest wall pain. Decision tree modeling was used to determine chest wall syndrome (CWS) thresholds for individual features. Significant features were determined using independent multivariate methods. These methods incorporate out‐of‐bag estimation using Random forests (RF) and bootstrapping (100 iterations) using decision trees.ResultsUnivariate analysis identified rib dose to 1 cc < 4000 cGy (P = 0.01), chest wall dose to 30 cc < 1900 cGy (P = 0.035), rib Dmax < 5100 cGy (P = 0.05) and lung dose to 1000 cc < 70 cGy (P = 0.039) to be statistically significant thresholds for avoiding CWS. Subsequent multivariate analysis confirmed the importance of rib dose to 1 cc, chest wall dose to 30 cc, and rib Dmax. Using learning‐curve experiments, the dataset proved to be self‐consistent and provides a realistic model for CWS analysis.ConclusionsUsing machine learning algorithms in this first of its kind study, we identify robust features and cutoffs predictive for the rare clinical event of CWS. Additional data in planned subsequent multicenter studies will help increase the accuracy of multivariate analysis.

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“…29,31 The comparison of studies should take into account the treatment duration and the doses per fraction according to the quadratic linear model. 31,[35][36][37] The alpha/beta ratio for healthy liver is quite low, from 1.5 13 to 3 38 . Murphy et al 33 postulates that the risk of hepatic toxicity for hypofractionated irradiation is overestimated in clinical practice when biological normalization is omitted.…”

Section: Hepatic Functions and Tumor Type Classical Data Showmentioning

confidence: 99%

Dose to organ at risk and dose prescription in liver SBRT

Rives

Izar

Parent

et al. 2017

Reports of Practical Oncology & Radiotherapy

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Concerning liver metastasis, SBRT can be safely delivered using one to five fractions. An excellent local control is obtained with doses from 20 to 60 Gy. For primary hepatic tumors, results are also good, but the risk of hepatic toxicity related to liver pre-existent pathology must be taken into account. Radiation induced liver disease (RILD) is not frequent in its classical presentation, but modifications of liver enzymes are often observed. Other toxicities of SBRT on the duodenum, small bowel and biliary tract are also described. With respect to contraindications and dose limitations on surrounding structures, SBRT is well tolerated and takes place among curative treatment of liver tumors, as surgery, radiofrequency and embolization.

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Chest Wall Toxicity After Stereotactic Body Radiotherapy for Malignant Lesions of the Lung and Liver

Cited by 98 publications

References 18 publications

Dosemetric Parameters Predictive of Rib Fractures after Proton Beam Therapy for Early-Stage Lung Cancer

Dosemetric Parameters Predictive of Rib Fractures after Proton Beam Therapy for Early-Stage Lung Cancer

Exploratory analysis using machine learning to predict for chest wall pain in patients with stage I non‐small‐cell lung cancer treated with stereotactic body radiation therapy

Dose to organ at risk and dose prescription in liver SBRT

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