Radiation Pneumonitis: Old Problem, New Tricks

Jain, Varsha; Berman, Abigail T.

doi:10.3390/cancers10070222

Cited by 131 publications

(111 citation statements)

References 98 publications

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“…Unlike the sites treated by LDRT for benign inflammatory conditions, the lung is radiosensitive. In radiotherapy for pulmonary neoplasms, breast carcinoma, esophageal carcinoma or Hodgkin's disease, the risk of complications to the normal pulmonary tissues is a major limitation in the prescription of the therapeutic dose (Jain and Berman 2018). Radiation-induced edema, pneumonitis and fibrosis are well-documented complications in such radiotherapy patients.…”

mentioning

confidence: 99%

“…The clinical presentation of radiation-induced lung damage principally depends on the lung volume irradiated, the radiation dose and the preexisting lung disease. There is some evidence that pretreatment inflammation in the lung would make pulmonary tissue more susceptible to radiation induced lung injury (Petit et al 2011;Castillo et al 2014;Chaudhuri et al 2016;Jain and Berman 2018). Pulmonary inflammation manifests as enhanced uptake of [ 18 F]fluorodeoxyglucose (FDG), hence allowing for quantitative assessment.…”

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confidence: 99%

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Low dose radiation therapy for COVID-19 pneumonia: is there any supportive evidence?

Salomaa

Cardis

Bouffler

et al. 2020

International Journal of Radiation Biology

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confidence: 99%

mentioning

confidence: 99%

Low dose radiation therapy for COVID-19 pneumonia: is there any supportive evidence?

Salomaa

Cardis

Bouffler

et al. 2020

International Journal of Radiation Biology

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“…Possible strategies to reduce the risk of RP include the use of four-dimensional CT ventilation for functional avoidance and IMRT. 12 The observation that all three patients had deterioration of symptoms and died after finishing or while tapering down steroid raised our concern. Two of our patients were initially managed by physicians as acute exacerbations of COPD with a short course of prednisolone 30 mg daily.…”

Section: Discussionmentioning

confidence: 94%

“…IMRT has been shown to carry a lower risk of RP compared with 3D conformal technique. 12 17% of the patients in the MDACC study were treated with proton therapy, which has been shown to significantly reduce V10 and V20 compared with photon techniques. 14 Our study results are likely more applicable to patients treated with conformal radiotherapy, which is still commonly used worldwide.…”

Section: Discussionmentioning

confidence: 99%

Risk of Radiation Pneumonitis after Post-lobectomy Thoracic Radiotherapy for Non-small-cell Lung Cancer

Chan

Nyaw

Tin

et al. 2020

Hong Kong Journal of Radiology

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Introduction: Patients who had lobectomy prior to thoracic radiotherapy may be more prone to developing radiation pneumonitis (RP) given their smaller remaining lung volume. There is no consensus on the normal lung dose constraints in this population. V20 ≤30% to 35% and mean lung dose (MLD) ≤20 Gy are common dose constraints used in definitive radiotherapy for lung cancer. We aimed to determine whether V20 ≤33% and mean MLD ≤20 Gy are safe constraints with an acceptable risk of RP in post-lobectomy patients. Methods: The data of all patients who received post-lobectomy thoracic radiotherapy for non-small-cell lung cancer at a single centre in Hong Kong from 2011 to 2018 were analysed retrospectively. The endpoint was Common Terminology Criteria for Adverse Events (CTCAE) grade ≥3 RP. Statistical analysis was performed to investigate whether V10 and V20 of whole lung were predictive factors for RP. Results: Fifty-five patients had been treated using the dose constraints of V20 ≤33% and MLD ≤20 Gy. Three patients developed grade 5 RP. No patients had grade 3 or 4 RP. There was no significant association between the V10, V20 and grade ≥3 RP. Conclusion: Our data showed that the risk of grade ≥3 RP was 5.5% in post-lobectomy patients using dose constraints of V20 ≤33% and MLD ≤20 Gy. Further prospective studies are necessary to clarify the optimal dose constraints in this population.

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“…Radiation pneumonitis (RP) is a well-known risk associated with thoracic tumor radiotherapy. 34 If the volume of normal lung receiving 20 Gy was lower than 22%, the possibility of RP with Grade 2 was limited. 35 Also, a possibility of 20% was found for patients with more than 50% lung volume receiving 10 Gy.…”

Section: Discussionmentioning

confidence: 99%

Non-coplanar VMAT improves plan quality for locoregional radiotherapy of left-sided breast cancer with internal mammary nodes

Xu¹,

Ma²,

Hu³

et al. 2020

Preprint

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Purpose A planning study was performed to evaluate the feasibility of non-coplanar volume modulated arc therapy (ncVMAT) for locoregional radiotherapy of left-sided breast cancer with internal mammary nodes. Methods and materials Ten patients with left-sided breast cancer after breast conserving surgery were retrospectively studied. The planning target volumes (PTV) were contoured encompassing the whole breast/chestwall, internal mammary nodes (IMN) and supraclavicular nodal (SCN) region. For each patient, ncVMAT plan with 4 partial arcs composing of two coplanar arcs and two non-coplanar arcs with couch rotating to 90˚ was generated. The prescription dose was normalized to cover 95% of PTV with 50 Gy delivering in 25 fractions. For each ncVMAT plan, dosimetric parameters were compared with coplanar VMAT (coVMAT) plan optimizing with identical coplanar beam angle arrangement. Results With ncVMAT, the mean conformity index of the whole PTV increased from 0.82±0.02 to 0.86±0.01 (p=0.005), and there was no significant difference for the homogeneity index. The mean coverage of internal mammary target volume (PTVimn) with ncVMAT increased from 88.77±3.07% to 91.67±3.84% comparing with coVMAT (p=0.005). Meanwhile, the V55 in PTVscn and PTVimn decreased significantly from 5.76±6.03%, 13.73±7.77% to 2.94±3.93%, 3.75±3.36%, separately (p<0.01). For organs at risk, the average V30, V20, V10, V5 and Dmean of heart decreased from 5.13±3.22%, 12.18±7.29%, 33.98±15.73%, 72.03±16.79% and 10.47±2.97 Gy to 4.86±2.54%, 9.35±5.43%, 25.16±12.42%, 62.27±13.18% and 9.08±2.34 Gy, separately (p<0.01). Furthermore, ncVMAT significantly reduced the mean V20, V10, V5, Dmean of left lung, and V10, V5, Dmean of contralateral lung (p<0.01). A better sparing of LAD descending coronary artery and right breast were also shown with ncVMAT (p<0.01). Conclusions Compared to coVMAT, ncVMAT provides better conformity, lower V55 in PTVscn and PTVimn, better coverage of PTVimn, better dose sparing in heart, bilateral lung, LAD and right breast for locoregional radiotherapy of left-sided breast cancer with internal mammary nodes, which potentially increase the local control in IMN and reduce the risk of deleterious effects.

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Radiation Pneumonitis: Old Problem, New Tricks

Cited by 131 publications

References 98 publications

Low dose radiation therapy for COVID-19 pneumonia: is there any supportive evidence?

Low dose radiation therapy for COVID-19 pneumonia: is there any supportive evidence?

Risk of Radiation Pneumonitis after Post-lobectomy Thoracic Radiotherapy for Non-small-cell Lung Cancer

Non-coplanar VMAT improves plan quality for locoregional radiotherapy of left-sided breast cancer with internal mammary nodes

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