Prognostic Value of Radiation Pneumonitis After Stereotactic Body Radiotherapy: Effect of Pulmonary Emphysema Quantitated Using CT Images

Yamamoto, Takaya; Satō, Yoshimichi; Matsushita, Haruo; Umezawa, Rei; Kubozono, Masaki; Ishikawa, Yojiro; Kozumi, Maiko; Takahashi, Noriyoshi; Mori­shita, Yohei; Katagiri, Yasuo; Sato, Kiyokazu; Ito, Kengo; Takeda, Ken; Jingu, Keiichi

doi:10.1016/j.cllc.2017.05.022

Cited by 11 publications

(10 citation statements)

References 21 publications

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“…Our study showed that increased %LAA-860 was associated with a significantly lower rate of consolidation changes at 6 months after SBRT treatment. Some other studies have reported similar results [4, 5]. Emphysema is anatomically equivalent to a lack of lung tissue.…”

Section: Discussionsupporting

confidence: 72%

“…Theoretically speaking, a lower probability of density changes after the treatment could lead to lower rates of RP. However, there are studies that suggest the opposite [24, 25], and Yamamoto et al found no significant association between %LAA-860 and Grade 2–3 RP [5]. It should be pointed out that in all of these studies, %LAA-860 represents the percentage of LAA-860 in the whole lung, rather than the emphysematous changes within the radiation field.…”

Section: Discussionmentioning

confidence: 99%

“…PE is usually diagnosed and graded by one or two doctors based on the pretreatment computed tomography (CT) scan, and subjective errors can occur [2–4]. However, recent studies have shown that PE can be graded by calculating the percentage of low attenuation area (%LAA), which is an objective quantitative measurement [5–7]. The %LAA has been defined as the percentage of LAA-860 or LAA-960 in the whole lung in most studies.…”

Section: Introductionmentioning

confidence: 99%

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Emphysema quantification on computed tomography and its value in predicting radiation pneumonitis in lung cancer treated by stereotactic body radiotherapy

Zhang

et al. 2019

Journal of Radiation Research

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A large portion of patients with early-stage non–small-cell lung cancer (NSCLC) who are receiving stereotactic body radiation therapy (SBRT) are medically inoperable due to compromised pulmonary function, and among these patients pulmonary emphysema (PE) is common. However, the relationship between PE and radiation-induced lung injuries remains unclear. In this study, we aimed to describe the full spectrum of computed tomography (CT) features after SBRT for NSCLC, and to explore their relationship with variables, including PE and dosimetric factors. In all, 71 patients were enrolled. PE was quantified as the percentage of low attenuation area [attenuation values of <−860 Hounsfield units (HU)] within the radiation field (%LAA-860). Spearman’s correlation and logistic regression were used to explore factors related to radiological features and radiation pneumonitis (RP). At the 1-year follow-up, acute radiological changes included: (i) diffuse consolidation, 11.3%; (ii) patchy consolidation and ground-glass opacities, 42.3%; and (iii) patchy ground-glass opacity, 14.1%. Late morphological changes occurred in 61.9% of patients (50.7% with a modified conventional pattern, 5.6% with a mass-like pattern and 5.6% with a scar-like pattern). Lower %LAA-860 was the only factor that was significantly associated with consolidation changes at 6 months after SBRT [odds ratio (OR), 0.008; P = 0.009], and it was also a significant predictor for Grade ≥ 2 RP (OR, 0.003; P = 0.04). Our study showed that patients with PE can benefit from SBRT on the condition that good control of dose–volume constraints is achieved.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Emphysema quantification on computed tomography and its value in predicting radiation pneumonitis in lung cancer treated by stereotactic body radiotherapy

Zhang

et al. 2019

Journal of Radiation Research

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“…(3) The model is highly in accordance with other published data in which the isocenter dose (also denoted as the maximum dose) was correlated with tumor local control [40, 41]. We used the Wennberg et al model to calculate the risk of RIP because it uses bilateral lung exclusive of the GTV as the definition of lung volume, which is generally recognized in lung SBRT [8, 13, 15]. The Din et al model and the Stam et al model are unique models that calculate the incidence of CWP and RIRF.…”

Section: Discussionmentioning

confidence: 72%

“…Although SBRT for NSCLC has achieved encouraging outcomes, radiation-induced pneumonitis (RIP), chest wall pain (CWP) and radiation-induced rib fractures (RIRF) are common side effects for NSCLC patients undergoing SBRT. The occurrence of grade ≥ 2 RIP, grade ≥ 2 CWP and symptomatic RIRF ranged between 9.4 and 20.3% [8–15], 10.9 and 39% [16–20] and 12.2 and 17.0% [21–23], respectively. Therefore, to develop a method for calculating the individualized fraction regime (IFR) capable of maintaining tumor control probability (TCP) while lowering the risk of normal tissues by considering the tumor size and proximity to the organs at risk (OAR) is a problem to be solved.…”

Section: Introductionmentioning

confidence: 99%

Calculating the individualized fraction regime in stereotactic body radiotherapy for non-small cell lung cancer based on uncomplicated tumor control probability function

Ping

Huang

2019

Radiat Oncol

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Background To calculate the individualized fraction regime (IFR) in stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC) patients using the uncomplicated tumor control probability (UTCP, P + ) function. Methods Thirty-three patients with peripheral lung cancer or lung metastases who had undergone SBRT were analyzed. Treatment planning was performed using the dose regime of 48 Gy in 4 fractions. Dose volume histogram (DVH) data for the gross tumor volume (GTV), lung, chest wall (CW) and rib were exported and the dose bin was multiplied by a certain percentage of the dose in that bin which ranged from 1 to 200% in steps of 1%. For each dose fraction, P + values were calculated by considering the tumor control probability (TCP), radiation-induced pneumonitis (RIP), chest wall pain (CWP) and radiation-induced rib fracture (RIRF). UTCP values as a function of physical dose were plotted and the maximum P + values corresponded to the optimal therapeutic gain. The IFR in 3 fractions was also calculated with the same method by converting the dose using the linear quadratic (LQ) model. Results Thirty-three patients attained an IFR using the introduced methods. All the patients achieved a TCP value higher than 92.0%. The IFR ranged from 3 × 10.8 Gy to 3 × 12.5 Gy for 3 fraction regimes and from 4 × 9.2 Gy to 4 × 10.7 Gy for 4 fraction regimes. Four patients with typical tumor characteristics demonstrated that the IFR was patient-specific and could maximize the therapeutic gain. Patients with a large tumor had a lower TCP and UTCP and a smaller fractional dose than patients with a small tumor. Patients with a tumor adjacent to the organ at risk (OAR) or at a high risk of RIP had a lower UTCP and a smaller fractional dose compared with patients with a tumor located distant from the OAR. Conclusions The proposed method is capable of predicting the IFR for NSCLC patients undergoing SBRT. Further validation in clinical samples is required.

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Stereotactic body radiotherapy in patients with chronic obstructive pulmonary disease and interstitial pneumonia: a review

2019

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Prognostic Value of Radiation Pneumonitis After Stereotactic Body Radiotherapy: Effect of Pulmonary Emphysema Quantitated Using CT Images

Cited by 11 publications

References 21 publications

Emphysema quantification on computed tomography and its value in predicting radiation pneumonitis in lung cancer treated by stereotactic body radiotherapy

Emphysema quantification on computed tomography and its value in predicting radiation pneumonitis in lung cancer treated by stereotactic body radiotherapy

Calculating the individualized fraction regime in stereotactic body radiotherapy for non-small cell lung cancer based on uncomplicated tumor control probability function

Stereotactic body radiotherapy in patients with chronic obstructive pulmonary disease and interstitial pneumonia: a review

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