Prediction of Chest Wall Toxicity From Lung Stereotactic Body Radiotherapy (SBRT)

Stephans, Kevin L.; Djemil, T.; Tendulkar, Rahul D.; Robinson, Clifford G.; Reddy, Chandana A.; Videtic, Gregory M.M.

doi:10.1016/j.ijrobp.2010.12.002

Cited by 120 publications

(94 citation statements)

References 25 publications

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“…Our MC‐computed rib doses were on the higher side of the recommended RTOG guidelines, similar to those previously reported 27 , 28 , 29 , 30 . However, RTOG 0915 report (7) strongly recommended that the lung SBRT treatment plan must be designed not to compromise target dose coverage and not to restrict potential delivery parameters for the sake of meeting the rib dose tolerances.…”

Section: Discussionsupporting

confidence: 85%

“…By identifying patient, tumor location, dosimetric parameters (i.e., conformity index, gradient, max chest wall dose or dose received by 20 cc of chest wall), and radiologic factors associated with their rib pain or chest wall toxicity, Lee and colleagues concluded that absolute dose of 65 Gy to 20 cc of chest wall volume was associated with radiation‐related chest wall toxicity. Similarly, another dosimetric study presented by Stephans et al (30) reviewed large cohort of patients and concluded that tumor size and chest wall dosimetry also correlated to late chest wall toxicity. In their study, volume of chest wall receiving 30 Gy through 70 Gy were highly significant for chest wall pain/rib fracture, such that they recommended 30 Gy to 30 cc or less, and/or 60 Gy to 3 cc or less for the chest wall.…”

Section: Discussionmentioning

confidence: 88%

“…There have been several studies reported in the literature about chest wall toxicity and rib fracture for lung SBRT patients 27 , 28 , 29 , 30 . Jain and colleagues (27) compared MC vs. PB algorithms for 20 consecutive patients following RTOG 0915 dosimetric criteria.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of Monte Carlo algorithm for compliance with RTOG 0915 dosimetric criteria in peripheral lung cancer patients treated with stereotactic body radiotherapy

Pokhrel

Sood

Badkul

et al. 2016

J Applied Clin Med Phys

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The purpose of the study was to evaluate Monte Carlo‐generated dose distributions with the X‐ray Voxel Monte Carlo (XVMC) algorithm in the treatment of peripheral lung cancer patients using stereotactic body radiotherapy (SBRT) with non‐protocol dose‐volume normalization and to assess plan outcomes utilizing RTOG 0915 dosimetric compliance criteria. The Radiation Therapy Oncology Group (RTOG) protocols for non‐small cell lung cancer (NSCLC) currently require radiation dose to be calculated using tissue density heterogeneity corrections. Dosimetric criteria of RTOG 0915 were established based on superposition/convolution or heterogeneities corrected pencil beam (PB‐hete) algorithms for dose calculations. Clinically, more accurate Monte Carlo (MC)‐based algorithms are now routinely used for lung stereotactic body radiotherapy (SBRT) dose calculations. Hence, it is important to determine whether MC calculations in the delivery of lung SBRT can achieve RTOG standards. In this report, we evaluate iPlan generated MC plans for peripheral lung cancer patients treated with SBRT using dose‐volume histogram (DVH) normalization to determine if the RTOG 0915 compliance criteria can be met. This study evaluated 20 Stage I‐II NSCLC patients with peripherally located lung tumors, who underwent MC‐based SBRT with heterogeneity correction using X‐ray Voxel Monte Carlo (XVMC) algorithm (Brainlab iPlan version 4.1.2). Total dose of 50 to 54 Gy in 3 to 5 fractions was delivered to the planning target volume (PTV) with at least 95% of the PTV receiving 100% of the prescription dose (V100%≥95%). The internal target volume (ITV) was delineated on maximum intensity projection (MIP) images of 4D CT scans. The PTV included the ITV plus 5 mm uniform margin applied to the ITV. The PTV ranged from 11.1 to 163.0 cc (mean=46.1±38.7 cc). Organs at risk (OARs) including ribs were delineated on mean intensity projection (MeanIP) images of 4D CT scans. Optimal clinical MC SBRT plans were generated using a combination of 3D noncoplanar conformal arcs and nonopposing static beams for the Novalis‐TX linear accelerator consisting of high‐definition multileaf collimators (HD‐MLCs: 2.5 mm leaf width at isocenter) and 6 MV‐SRS (1000 MU/min) beam. All treatment plans were evaluated using the RTOG 0915 high‐ and intermediate‐dose spillage criteria: conformity index (R100%), ratio of 50% isodose volume to the PTV (R50%), maximum dose 2 cm away from PTV in any direction (normalD2cm), and percent of normal lung receiving 20 Gy normalV20 or more. Other OAR doses were documented, including the volume of normal lung receiving 5 Gy normalV5 or more, dose to <0.35 cc of spinal cord, and dose to 1000 cc of total normal lung tissue. The dose to <1 cc, <5 cc, <10 cc of ribs, as well as maximum point dose as a function of PTV, prescription dose, and a 3D distance from the tumor isocenter to the proximity of the rib contour were also examined. The biological effective dose (BED) with α/β ratio of 3 Gy for ribs was analyzed. All 20 patients either fully met or were withi...

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 88%

See 1 more Smart Citation

Assessment of Monte Carlo algorithm for compliance with RTOG 0915 dosimetric criteria in peripheral lung cancer patients treated with stereotactic body radiotherapy

Pokhrel

Sood

Badkul

et al. 2016

J Applied Clin Med Phys

View full text Add to dashboard Cite

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“…All patients were planned with a constraint goal to keep 30 cc of the chest wall to <30.0 Gy. Twenty‐five parameters (termed features in the machine learning analysis) suspected of a correlation or previously reported10, 12, 13, 15, 17, 27, 28, 29, 30, 31 to associate with CWS were analyzed, including patient and tumor characteristics and dosimetric features were recorded for each patient. Toxicities were assessed using CTCAEv4 criteria for chest wall pain, where Grade 1 represents mild pain, Grade 2 represents moderate pain limiting instrumental activities of daily living (ADL), and Grade 3 represents severe pain limiting self‐care ADL.…”

Section: Methodsmentioning

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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“…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%

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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Prediction of Chest Wall Toxicity From Lung Stereotactic Body Radiotherapy (SBRT)

Cited by 120 publications

References 25 publications

Assessment of Monte Carlo algorithm for compliance with RTOG 0915 dosimetric criteria in peripheral lung cancer patients treated with stereotactic body radiotherapy

Assessment of Monte Carlo algorithm for compliance with RTOG 0915 dosimetric criteria in peripheral lung cancer patients treated with stereotactic body radiotherapy

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

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

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