Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients

Kwa, Stefan L.S.; Lebesque, Joos V.; Theuws, Jacqueline; Marks, Lawrence B.; Munley, M.T.; Bentel, Gunilla C.; Oetzel, Dieter; Spahn, Uwe; Graham, Mary V.; Drzymala, Robert E.; Purdy, James A.; Lichter, Allen S.; Martel, Mary K.; Haken, R.K. Ten

doi:10.1016/s0360-3016(98)00196-5

Cited by 670 publications

(392 citation statements)

References 20 publications

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“…Thus, 20 Gy, 30%, and 30% were used as cut-points for these three metrics, respectively, to define the patient subgroups in this study. These cut-points are consistent with prior analyses [3,4,8,10]. The cut-point used for GTV was 100 cm 3 , which corresponded with the median value.…”

Section: Patient Subgroupssupporting

confidence: 83%

“…Several studies have successfully correlated the risk of developing RT-induced lung injury with 3D dose parameters such as mean lung dose (MLD) and the percentage of lung volume receiving ≥ 20 Gy (V20) [4,[7][8][9][10][11]. These findings are encouraging, in that they demonstrate the ability of 3D tools to predict normal tissue risks [9].…”

Section: Introductionmentioning

confidence: 92%

“…However, dosimetric parameters alone are not ideal predictors for lung injury [4,[8][9][10][11]. Several recent studies have investigated transforming growth factor-beta-1 (TGF-β1) as a predictor for RT-induced lung injury [1,3,7,[12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Does transforming growth factor-β1 predict for radiation-induced pneumonitis in patients treated for lung cancer?

et al. 2006

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The purpose of the study was to reassess the utility of transforming growth factor-beta-1 (TGF-β1) together with dosimetric and tumor parameters as a predictor for radiation pneumonitis (RP). Of the 121 patients studied, 32 (26.4%) developed grade ≥ 1 RP, and 27 (22.3%) developed grade ≥ 2 RP. For the endpoint of grade ≥ 1 RP, those with V30 > 30% and an end-RT/baseline TGF-β1 ratio ≥ 1 had a significantly higher incidence of RP than did those with V30 > 30% and an end-RT/baseline TGF-β1 ratio < 1. For most other patient groups, there were no clear associations between TGF-β1 values and rates of RP. These findings suggest that TGF-β1 is generally not predictive for RP except for the group of patients with a high V30.

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Section: Patient Subgroupssupporting

confidence: 83%

Section: Introductionmentioning

confidence: 92%

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Does transforming growth factor-β1 predict for radiation-induced pneumonitis in patients treated for lung cancer?

et al. 2006

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“…A study reported by Kwa et al (34) that included 540 patients, found no radiation pneumonitis for 64 patients who received a mean lung dose up to 8 Gy, which is higher than the 5.57 Gy mean lung dose (Gy) by our MP‐VMAT design. The probability of developing Grade 2 radiation pneumonitis was low for patients who had less than 22% of normal lung volume irradiated with more than 20 Gy (35) .…”

Section: Discussioncontrasting

confidence: 49%

The feasibility study of using multiple partial volumetric‐modulated arcs therapy in early stage left‐sided breast cancer patients

Tsai

Lin

Lee

et al. 2012

J Applied Clin Med Phys

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The purpose of this study was to assess the feasibility of using a multiple partial volumetric‐modulated arcs therapy (MP‐VMAT) technique on the left breast irradiation and to evaluate the dosimetry and treatment efficiency. Ten patients with left‐sided breast cancer who had been treated by whole breast irradiation were selected for the treatment plan evaluation by using six partial volumetric modulated arcs. Each arc consisted of a 50° gantry rotation. The planning target volumes and the normal organs, including the right breast, the bilateral lungs, left ventricle, heart, and unspecified tissue, were contoured on the CT images. Dose‐volume histograms were generated and the delivery time for each arc was recorded. The PTV received greater than 95% of the V95 for all cases, and the maximum dose was within ±1% of 110% of the prescription dose. The mean homogeneity index (HI) was 10.61±0.99, and mean conformity index (CI) was 1.21±0.03. The mean dose, V5, V10, V25, and V30 of the heart were 7.61±1.38 Gy, 59.73% ±15.87%, 24.39% ±6.82%, 2.52% ±1.11%, and 1.57% ±0.71%, respectively. The volume of the left ventricle receiving 25 Gy was 5.15% ±2.23%. The total lung mean dose was 5.57±0.36 Gy, with V5 of 25.39% ±3.88% and V20 of 5.66% ±0.89%. The right breast received a mean dose of 2.13±0.22 Gy, with V5 of 1.83% ±1.22% and V10 of 0.04% ±0.12%. The mean dose of unspecified tissue was 5.34±0.37 Gy and V5 was 22.23% ±1.57%. The volume of the unspecified tissue receiving 50 Gy was 0.50% ±0.14%. The mean delivery time for each arc was 13.9 seconds. The average MU among ten patients was 511 MU (range 443 to 594 MUs). The MP‐VMAT technique for the left‐sided breast cancer patients achieved adequate target dose coverage while maintaining low doses to organs‐at‐risk, and therefore reduced the potential for induction of second malignancy and side effects. The highly efficient treatment delivery would be beneficial for improving patient throughput, providing patient comfort, and achieving precise treatment with the breathing control system.PACS number: 87.55.‐x, 87.55.D‐, 87.55.dk

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“…In recent years, a number of works have provided parameter estimates, including statistical uncertainties, for several different normal tissues. Recent SDR model parameter estimates include those for the parotid gland, ( 18 – 20 ) the heart, (21) the lung, ( 22 – 24 ) and the liver (25) (26) For further details (e.g., treatment techniques, parameters) about the clinical data on which each of these parameter estimates is based, the reader is referred to the original papers.…”

Section: Methodsmentioning

confidence: 99%

A TCP‐NTCP estimation module using DVHs and known radiobiological models and parameter sets

Warkentin

Stavrev

Stavreva

et al. 2004

J Applied Clin Med Phys

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Radiotherapy treatment plan evaluation relies on an implicit estimation of the tumor control probability (TCP) and normal tissue complication probability (NTCP) arising from a given dose distribution. A potential application of radiobiological modeling to radiotherapy is the ranking of treatment plans via a more explicit determination of TCP and NTCP values. Although the limited predictive capabilities of current radiobiological models prevent their use as a primary evaluative tool, radiobiological modeling predictions may still be a valuable complement to clinical experience. A convenient computational module has been developed for estimating the TCP and the NTCP arising from a dose distribution calculated by a treatment planning system, and characterized by differential (frequency) dose‐volume histograms (DDVHs). The radiobiological models included in the module are sigmoidal dose response and Critical Volume NTCP models, a Poisson TCP model, and a TCP model incorporating radiobiological parameters describing linear‐quadratic cell kill and repopulation. A number of sets of parameter values for the different models have been gathered in databases. The estimated parameters characterize the radiation response of several different normal tissues and tumor types. The system also allows input and storage of parameters by the user, which is particularly useful because of the rapidly increasing number of parameter estimates available in the literature. Potential applications of the system include the following: comparing radiobiological predictions of outcome for different treatment plans or types of treatment; comparing the number of observed outcomes for a cohort of patient DVHs to the predicted number of outcomes based on different models/parameter sets; and testing of the sensitivity of model predictions to uncertainties in the parameter values. The module thus helps to amalgamate and make more accessible current radiobiological modeling knowledge, and may serve as a useful aid in the prospective and retrospective analysis of radiotherapy treatment plans.PACS number: 87.53.Tf

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Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients

Cited by 670 publications

References 20 publications

Does transforming growth factor-β1 predict for radiation-induced pneumonitis in patients treated for lung cancer?

Does transforming growth factor-β1 predict for radiation-induced pneumonitis in patients treated for lung cancer?

The feasibility study of using multiple partial volumetric‐modulated arcs therapy in early stage left‐sided breast cancer patients

A TCP‐NTCP estimation module using DVHs and known radiobiological models and parameter sets

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