Risk factors for symptomatic radiation pneumonitis after stereotactic body radiation therapy (SBRT) in patients with non-small cell lung cancer

Impact of tumor size and location on lung dose difference between stereotactic body radiation therapy techniques for non‐small cell lung cancer

“…Furthermore, these dosimetric characteristics of the 3D-CRT plans compared to the IMRT plans with steeper DVH lines and homogeneous PTV doses may be related to the increased differences in highdose parameters with increasing PTV. Regarding the clinical significance of the increased MLD and V5-30 in the IMRT plans, the mean (6.44 Gy, 3.88 Gy, and 5.48%) and maximum (10.82 Gy, 6.56 Gy, and 11.52%) values for the ipsilateral MLD, bilateral MLD, and bilateral V20 in the IMRT plans of all 31 tumors were within safe limits for symptomatic RP risk recommended by the HyTEC report and Liu et al 14,15 Together with these values within safe limits, our small differences between the two techniques in these parameters are unlikely to be related to clinically significant differences.…”

“…[10][11][12][13] Additionally, in a recent hypofractionated treatment effects in the clinic (HyTEC) report and a large study by Liu et al, MLDs less than 6-8 Gy and 20 Gy for the total lung and ipsilateral lung, respectively, and a percent of the total lung volume receiving >20 Gy (V20) less than 10%-15% were suggested as appropriate dosimetric guidance to limit the rate of symptomatic RP to 10%-15% after lung SBRT. 14,15 The selection of a proper technique in SBRT for lung cancer needs to be considered for improved dosimetry in both target and adjacent normal tissues, including lung tissue. In addition, this dosimetric improvement for normal lung tissue can lead to a reduction in the RP risk after lung SBRT.…”

Value of carbon-ion radiotherapy for early stage non-small cell lung cancer

“…Other risk factors included previous thoracic radiation, right lung location, mean lung doses of total or ipsilateral lung, and total lung volume receiving 20 Gy and so on. In this study, a model using dose volume histograms (DVH) established that the patients should have had no previous lung radiation and that the mean dose of total and ipsilateral lungs should be kept at less than 6 Gy and 20 Gy, in order to ensure keeping the RP2 rate under 10% [48] .…”

Symptomatic Radiation Pneumonitis After Stereotactic Body Radiation Therapy for Multiple Pulmonary Oligometastases or Synchronous Primary Lung Cancer

“…Radiation pneumonitis (RP) is the most common pulmonary toxic effect, and there is an association between the irradiated volume and RP. 4 , 5 , 6 A UK consensus recommends the following: (1) lung (normal lungs minus gross tumor volume) V 20Gy < 12.5% is optimal (V x Gy is the volume of the organ at risk receiving ≥ x Gy), and < 15% is acceptable when patients with more than 1 lung lesion are treated with SBRT; and (2) these lesions should be treated on alternate days and with the same dose and fractionation. 7 , 8 , 9 In clinical practice, SBRT is sometimes delivered in relatively large target volumes using a different dose and fractionation, depending on the timing of systemic therapy, the general condition of the patient, and the tumor locations.…”