Organs at Risk Considerations for Thoracic Stereotactic Body Radiation Therapy: What Is Safe for Lung Parenchyma?

Kong, Feng-Ming Spring; Moiseenko, Vitali; Zhao, Jing; Milano, Michael T.; Li, Ling; Rimner, Andreas; Das, Shiva K.; Li, X. Allen; Miften, Moyed; Liao, Zhongxing; Martel, Mary K.; Bentzen, Søren M.; Jackson, Andrew; Grimm, Jimm; Marks, Lawrence B.; Yorke, Ellen

doi:10.1016/j.ijrobp.2018.11.028

Cited by 62 publications

(65 citation statements)

References 88 publications

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“…Inclusion requirements were patients with at least 6 months of follow up after completion of SBRT (n = 91) or documented evidence of symptomatic RP with less than 6 months of follow up (n = 2). Near equivalent tumoricidal (α/β = 10 Gy) biological effective dose schemes (BED10) of 100-105 Gy were required in the interest of reporting homogeneous fractionation schemes as recommended by the AAPM (e.g., 50/5, 48/ 4, 60/8) [5,15]. Diagnosis of RP required clinical symptoms (i.e.…”

Section: Methodsmentioning

confidence: 99%

“…cough or dyspnea requiring increased steroids from baseline with or without interference in activities of daily living) and radiographic evidence, to qualify as an event. As a result, all patients in this study deemed to have "symptomatic RP" were Grade 2+ per CTCAE v3.0/4.0/5.0 or Grade 3+ per RTOG toxicity grading criteria, similarly as analyzed by the AAPM [5]. Chart reviewers recorded patient and tumor characteristics, and were blinded to DVH parameters during the chart review process.…”

Section: Methodsmentioning

confidence: 99%

“…Symptomatic radiation pneumonitis (RP) is a wellknown subacute side effect of SBRT with reported occurrences ranging from approximately 10-20% of patients treated with commonly used fractionation schemes [4][5][6][7]. Symptomatic RP generally occurs within 1 year, typically within 3-6 months, following completion of SBRT, [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…The American Association of Physicists in Medicine (AAPM) Working Group on Biological Effects of SBRT recently recommended new reporting guidelines for papers discussing toxicity from lung SBRT in late 2018 [5]. This work investigates carefully selected patients who were treated with therapeutic doses of SBRT as recommended by Hypofractionated Treatment Effects in the Clinic (HyTEC) [15].…”

Section: Introductionmentioning

confidence: 99%

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Correlation of dosimetric factors with the development of symptomatic radiation pneumonitis in stereotactic body radiotherapy

et al. 2020

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Background: The development of radiation pneumonitis (RP) after Stereotactic Body Radiotherapy (SBRT) is known to be associated with many different factors, although historical analyses of RP have commonly utilized heterogeneous fractionation schemes and methods of reporting. This study aims to correlate dosimetric values and their association with the development of Symptomatic RP according to recent reporting standards as recommended by the American Association of Physicists in Medicine. Methods: We performed a single-institution retrospective review for patients who received SBRT to the lung from 2010 to 2017. Inclusion criteria required near-homogeneous tumoricidal (α/β = 10 Gy) biological effective dose (BED10) of 100-105 Gy (e.g., 50/5, 48/4, 60/8), one or two synchronously treated lesions, and at least 6 months of follow up or documented evidence of pneumonitis. Symptomatic RP was determined clinically by treating radiation oncologists, requiring radiographic evidence and the administration of steroids. Dosimetric parameters and patient factors were recorded. Lung volumes subtracted gross tumor volume(s). Wilcoxon Rank Sums tests were used for nonparametric comparison of dosimetric data between patients with and without RP; p-values were Bonferroni adjusted when applicable. Logistic regressions were conducted to predict probabilities of symptomatic RP using univariable models for each radiation dosimetric parameter. Results: The final cohort included 103 treated lesions in 93 patients, eight of whom developed symptomatic RP (n = 8; 8.6%). The use of total mean lung dose (MLD) > 6 Gy alone captured five of the eight patients who developed symptomatic RP, while V20 > 10% captured two patients, both of whom demonstrated a MLD > 6 Gy. The remaining three patients who developed symptomatic RP without exceeding either metric were noted to have imaging evidence of moderate interstitial lung disease, inflammation of the lungs from recent concurrent chemoradiation therapy to the contralateral lung, or unique peri-tumoral inflammatory appearance at baseline before treatment. Conclusions: This study is the largest dosimetric analysis of symptomatic RP in the literature, of which we are aware, that utilizes near-homogenous tumoricidal BED fractionation schemes. Mean lung dose and V20 are the most consistently reported of the various dosimetric parameters associated with symptomatic RP. MLD should be considered alongside V20 in the treatment planning process. Trial registration: Retrospectively registered on IRB 398-17-EP.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Correlation of dosimetric factors with the development of symptomatic radiation pneumonitis in stereotactic body radiotherapy

et al. 2020

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“…The detailed grading definitions were previously described in our previous publications (2,12), consistent with a recent update from the expert panel of an AAPM task ( Supplementary Table S1; ref. 26).…”

Section: Evaluation Of Radiation Pneumonitismentioning

confidence: 99%

Machine Learning to Build and Validate a Model for Radiation Pneumonitis Prediction in Patients with Non–Small Cell Lung Cancer

Wang

et al. 2019

Clinical Cancer Research

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Purpose: Radiation pneumonitis is an important adverse event in patients with non-small cell lung cancer (NSCLC) receiving thoracic radiotherapy. However, the risk of radiation pneumonitis grade ! 2 (RP2) has not been well predicted. This study hypothesized that inflammatory cytokines or the dynamic changes during radiotherapy can improve predictive accuracy for RP2. Experimental Design: Levels of 30 inflammatory cytokines and clinical information in patients with stages I-III NSCLC treated with radiotherapy were from our prospective studies. Statistical analysis was used to select predictive cytokine candidates and clinical covariates for adjustment. Machine learning algorithm was used to develop the generalized linear model for predicting risk RP2. Results: A total of 131 patients were eligible and 17 (13.0%) developed RP2. IL8 and CCL2 had significantly (Bonferroni) lower expression levels in patients with RP2 than without RP2. But none of the changes in cytokine levels during radiotherapy was significantly associated with RP2. The final predictive GLM model for RP2 was established, including IL8 and CCL2 at baseline level and two clinical variables. Nomogram was constructed based on the GLM model. The model's predicting ability was validated in the completely independent test set (AUC ¼ 0.863, accuracy ¼ 80.0%, sensitivity ¼ 100%, specificity ¼ 76.5%). Conclusions: By machine learning, this study has developed and validated a comprehensive model integrating inflammatory cytokines with clinical variables to predict RP2 before radiotherapy that provides an opportunity to guide clinicians.

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Prospective Data on Stereotactic Ablative Radiotherapy Provides Guidance in an Unusual Clinical Scenario

Weiner,

Marks

2024

JAMA Oncol

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Organs at Risk Considerations for Thoracic Stereotactic Body Radiation Therapy: What Is Safe for Lung Parenchyma?

Cited by 62 publications

References 88 publications

Correlation of dosimetric factors with the development of symptomatic radiation pneumonitis in stereotactic body radiotherapy

Correlation of dosimetric factors with the development of symptomatic radiation pneumonitis in stereotactic body radiotherapy

Machine Learning to Build and Validate a Model for Radiation Pneumonitis Prediction in Patients with Non–Small Cell Lung Cancer

Prospective Data on Stereotactic Ablative Radiotherapy Provides Guidance in an Unusual Clinical Scenario

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