Radiation Pneumonitis After Volumetric Modulated Arc Therapy for Non-small Cell Lung Cancer

Doi, Hiroshi; Igeta, Masataka; Suzuki, Hitomi; Kitajima, Kazuhiro; Tanooka, Masao; Ishida, Tatsuhiro; Wakayama, Tsukasa; Yokoi, Takashi; Kuribayashi, Kozo; Kijima, Takashi; Hashimoto, Masaki; Kondo, Nobuyuki; Matsumoto, Seiji; Hasegawa, Seiki; Kamikonya, Norihiko; Yamakado, Koichiro

doi:10.21873/anticanres.15396

Cited by 12 publications

(8 citation statements)

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“…Dosimetrically, MLD, V5, and V20 are most commonly reported as predictors of radiation pneumonitis. [7][8][9]25 A MLD of >4 Gy has shown to be a predictor for RP. 26,27 Within our three patients that developed VRTOG Grades 2 and 3 acute effects, the median MLD was 3.2 Gy with a mean MLD of 3.4 Gy.…”

Section: Discussionmentioning

confidence: 99%

“…When retrospectively reviewing the radiation treatment plans, the following data were collected from Eclipse: GTV, PTV, median GTV dose, dose to 98% (D98) of the GTV, dose to 2% (D2) of the GTV, median PTV dose, D98 of the PTV, D2 of the PTV, the gradient measure (GM), median lung dose (MLD), and the percentage of lung receiving 5 Gy (V5) and 20 Gy (V20) as well as the dose received by 30% (D30) of the lung. [6][7][8][9] The volume of the PTV that received prescription and the volume of the body receiving prescription were also gathered to calculate the conformity index (CI). The CI is an objective measurement of the conformity of a high dose region to the target volume using the formula (TV PIV ) 2 /(TV Â PIV) where the TV PIV is the volume of the PTV receiving prescription, TV is the volume of the PTV, and PIV is the volume of the body that is receiving prescription.…”

Section: Radiation Treatment Planningmentioning

confidence: 99%

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Retrospective study evaluating the efficacy of stereotactic body radiation therapy for the treatment of confirmed or suspected primary pulmonary carcinomas in dogs

Martin,

LaRue,

Griffin

et al. 2023

Vet Comparative Oncology

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Canine primary pulmonary carcinomas (PCCs) are commonly treated with surgery with overall median survival times (MST) around a year; however, due to extent of disease, prognosis, or client preference, alternative treatments have been considered. Stereotactic body radiation therapy (SBRT) has been utilized in human cancer patients for local control of lung tumours as a surgical alternative. Twenty‐one PCCs in 19 dogs that received SBRT for local control were retrospectively evaluated. Dogs were staged according to the canine lung carcinoma stage classification (CLCSC) system with three as Stage 1, five as Stage 2, three as Stage 3, and eight as Stage 4. Overall MST was 343 days with 38% of patients alive at 1 year. Stage did not significantly impact survival time (p = .72). Five (26%) dogs had lymphadenopathy and MST was not significantly different from dogs without lymphadenopathy (343 vs. 353 days; p = .54). Five out of 18 evaluable dogs (28%) experienced acute lung VRTOG effects and 2 of 12 dogs (17%) experienced late lung VRTOG effects. Median lung dose, V5, V20, and D30 to the lung did not correlate significantly with the development of adverse radiation events. Twelve dogs had follow‐up imaging and the best response included a complete response (17%), partial response (42%), and stable disease (42%). Progressive disease was noted in seven dogs a median of 229 days after SBRT. SBRT was documented to be a safe and effective alternative to surgery and may have survival advantages for Stage 3 or 4 dogs according to the CLCSC.

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Section: Discussionmentioning

confidence: 99%

Section: Radiation Treatment Planningmentioning

confidence: 99%

Retrospective study evaluating the efficacy of stereotactic body radiation therapy for the treatment of confirmed or suspected primary pulmonary carcinomas in dogs

Martin,

LaRue,

Griffin

et al. 2023

Vet Comparative Oncology

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“…30 Fujiwara et al assessed the incidence and grade of radiation pneumonitis after volumetric modulated arc therapy (VMAT) for the management of NSCLC. 33 A total of 50 patients were included in the study, and radiation pneumonitis developed in 38 (76%) patients, 11 of whom suffered from ≥grade 2 radiation pneumonitis. The authors reported that the percentage of lung volume receiving a dose over 5 Gy (V5), 10 Gy (V10), 20 Gy (V20) and 30 Gy (V30), and MLD in the bilateral and ipsilateral lung were significantly associated with the development of grade ≥2 radiation pneumonitis.…”

Section: Discussionmentioning

confidence: 99%

“…30 It is pertinent to respect lung dose-volume constraints in radiotherapeutic management of NSCLC to avoid radiation pneumonitis as evidenced by the aforementioned studies and recent guidelines. [31][32][33] Violation of dose-volume constraints may result in severe radiation pneumonitis which may lead to morbidity, deterioration in the quality of life, and mortality in fragile patients with comorbidities such as chronic obstructive pulmonary disease. 34,35 Also, patients with radiation pneumonitis may suffer from additional burdens due to the requirement of therapies such as antibiotics and steroids.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Physical Lung Dose-Volume Parameters in Patients Receiving Split Course Radiation Therapy for Advanced-Stage Non Small Cell Lung Cancer: Dosimetric Effect of Active Breathing Control and Clinical Implications: Analytical Research, Case-Control

GÜNDEM¹,

ELÇİM²

2022

Turkiye Klinikleri J Med Sci

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Active breathing control (ABC) system serves as a viable technique for the management of respiratory motion by providing reproducible breath-holding. Herein, we assess physical lung dose-volume parameters of V20 (total lung volume receiving ≥20 Gy) and mean total lung dose (MLD) in a series of patients receiving split course radiation therapy (SCRT) for advanced-stage non-small cell lung cancer (NSCLC) with the incorporation of the ABC system. Material and Methods: A series of 22 patients receiving ABC-guided SCRT for advanced-stage NSCLC were evaluated for physical lung dose-volume parameters of V20 and MLD. Two different radiation therapy plans have been generated for every patient with and without the incorporation of the ABC system to investigate the dosimetric impact. Results: Mean V20 and MLD were 32.3% and 2,104 cGy, respectively at freebreathing. Mean V20 and MLD were 24.7% and 1,697 cGy, respectively with the incorporation of the ABC system. The decrease in V20 and MLD was 23.53% and 19.34%, respectively. Conclusion: Our study shows improved normal lung tissue sparing by incorporation of ABC system in SCRT of advanced-stage NSCLC. The reduction in V20 and MLD may have clinical implications. Improved normal lung tissue sparing by use of the ABC system may result in an improved toxicity profile of radiation delivery and thereby enable dose escalation in selected patients. Admittedly, clinical follow-up of patients should be performed to elucidate clinical reflections of dosimetric gains achieved by the ABC system.

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“…But still the incidence of pneumonitis grade ≥ 3 lies between 2 and 7%, though just 60-74 Gy were applied [18][19][20]. Modern studies of patients treated with VMAT, applying 60-70 Gy, show an incidence of pneumonitis grade ≥ 2 between 22 and 28% [21][22][23].…”

Section: Pneumonitismentioning

confidence: 99%

Locally advanced NSCLC: a plea for sparing the ipsilateral normal lung—prospective, clinical trial with DART-bid (dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily) by VMAT

et al. 2022

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Background In radiation treatment of locally advanced non-small cell lung cancer (LA-NSCLC), ‘margins’ from internal target volumes to planning target volumes in the range of 12 to 23 mm are reported, and avoiding exposure of the contralateral lung is common practice. We investigated prospectively an approach with tight margins (7 mm) and maximal sparing of the ipsilateral normal lung. Mature results for the first endpoint (pneumonitis) and further toxicities are reported. Methods Primary tumors were treated by VMAT with 73.8–90.0 Gy in positive correlation to tumor volumes, nodes with 61.2 Gy, a restricted volume of nodes electively with 45 Gy. Fractional doses of 1.8 Gy bid, interval 8 h. Before radiotherapy, two cycles platin-based chemotherapy were given. 12 patients finished maintenance therapy with Durvalumab. Median follow up time for all patients is 19.4 months, for patients alive 27.0 months (3.4–66.5 months). Results 100 consecutive, unselected patients with LA-NSCLC in stages II through IVA were enrolled (UICC/AJCC, 8th edition). No acute grade 4/5 toxicity occurred. Pneumonitis grade 2 and 3 was observed in 12% and 2% of patients, respectively; lowering the risk of pneumonitis grade ≥ 2 in comparison to the largest study in the literature investigating pneumonitis in LA-NSCLC, is significant (p < 0.0006). Acute esophageal toxicity grade 1, 2 and 3 occurred in 12%, 57% and 3% of patients, respectively. Two patients showed late bronchial stricture/atelectasis grade 2. In two patients with lethal pulmonary haemorrhages a treatment correlation cannot be excluded. Median overall survival for all stage III patients, and for those with ‘RTOG 0617 inclusion criteria’ is 46.6 and 50.0 months, respectively. Conclusions Overall toxicity is low. In comparison to results in the literature, maximal sparing the ipsilateral normal lung lowers the risk for pneumonitis significantly. Trial registration Ethics committee of Vorarlberg, Austria; EK-0.04-105, Registered 04/09/2017—Retrospectively registered. http://www.ethikkommission-vorarlberg.at

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Radiation Pneumonitis After Volumetric Modulated Arc Therapy for Non-small Cell Lung Cancer

Cited by 12 publications

References 0 publications

Retrospective study evaluating the efficacy of stereotactic body radiation therapy for the treatment of confirmed or suspected primary pulmonary carcinomas in dogs

Retrospective study evaluating the efficacy of stereotactic body radiation therapy for the treatment of confirmed or suspected primary pulmonary carcinomas in dogs

Assessment of Physical Lung Dose-Volume Parameters in Patients Receiving Split Course Radiation Therapy for Advanced-Stage Non Small Cell Lung Cancer: Dosimetric Effect of Active Breathing Control and Clinical Implications: Analytical Research, Case-Control

Locally advanced NSCLC: a plea for sparing the ipsilateral normal lung—prospective, clinical trial with DART-bid (dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily) by VMAT

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