Heart dosimetry is correlated with risk of radiation pneumonitis after lung-sparing hemithoracic pleural intensity modulated radiation therapy for malignant pleural mesothelioma Journal Article


Authors: Yorke, E. D.; Jackson, A.; Kuo, L. C.; Ojo, A.; Panchoo, K.; Adusumilli, P.; Zauderer, M. G.; Rusch, V. W.; Shepherd, A.; Rimner, A.
Article Title: Heart dosimetry is correlated with risk of radiation pneumonitis after lung-sparing hemithoracic pleural intensity modulated radiation therapy for malignant pleural mesothelioma
Abstract: Purpose To determine clinically helpful dose-volume and clinical metrics correlating with symptomatic radiation pneumonitis (RP) in malignant pleural mesothelioma (MPM) patients with 2 lungs treated with hemithoracic intensity modulated pleural radiation therapy (IMPRINT). Methods and Materials Treatment plans and resulting normal organ dose-volume histograms of 103 consecutive MPM patients treated with IMPRINT (February 2005 to January 2015) to the highest dose ≤50.4 Gy satisfying departmental normal tissue constraints were uniformly recalculated. Patient records provided maximum RP grade (Common Terminology Criteria for Toxicity and Adverse Event version 4.0) and clinical and demographic information. Correlations analyzed with the Cox model were grade ≥2 RP (RP2+) and grade ≥3 RP (RP3+) with clinical variables, with volumes of planning target volume (PTV) and PTV-lung overlap and with mean dose, percent volume receiving dose D (VD), highest dose encompassing % volume V, (DV), and heart, total, ipsilateral, and contralateral lung volumes. Results Twenty-seven patients had RP2+ (14 with RP3+). The median prescription dose was 46.8 Gy (39.6-50.4 Gy, 1.8 Gy/fraction). The median age was 67.6 years (range, 42-83 years). There were 79 men, 40 never-smokers, and 44 with left-sided MPM. There were no significant (P≤.05) correlations with clinical variables, prescription dose, total lung dose-volume metrics, and PTV-lung overlap volume. Dose-volume correlations for heart were RP2+ with VD (35 ≤ D ≤ 47 Gy, V43 strongest at P=.003), RP3+ with VD (31 ≤ D ≤ 45 Gy), RP2+ with DV (5 ≤ V ≤ 30%), RP3+ with DV (15 ≤ V ≤ 35%), and mean dose. Significant for ipsilateral lung were RP2+ with VD (38 ≤ D ≤ 44 Gy), RP3+ with V41, RP2+ and RP3+ with minimum dose, and for contralateral lung, RP2+ with maximum dose. Correlation of PTV with RP2+ was strong (P<.001) and also significant with RP3+. Conclusions Heart dose correlated strongly with symptomatic RP in this large cohort of MPM patients with 2 lungs treated with IMPRINT. Planning constraints to reduce future heart doses are suggested. © 2017 Elsevier Inc.
Keywords: adult; aged; aged, 80 and over; middle aged; intensity modulated radiation therapy; proportional hazards models; radiotherapy dosage; radiotherapy; patient monitoring; diagnostic imaging; radiation response; proportional hazards model; tumors; radiotherapy, intensity-modulated; conservative treatment; lung; mesothelioma; radiotherapy planning, computer-assisted; kaplan meier method; patient treatment; respiration; biological organs; heart; pleural neoplasms; adverse effects; kaplan-meier estimate; breathing; radiation pneumonitis; common terminology criteria; planning target volumes; procedures; organs at risk; malignant pleural mesotheliomas; methods and materials; very elderly; organ sparing treatments; humans; human; male; female; radiotherapy planning system; normal tissue constraints; demographic information
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 99
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2017-09-01
Start Page: 61
End Page: 69
Language: English
DOI: 10.1016/j.ijrobp.2017.04.025
PUBMED: 28816162
PROVIDER: scopus
PMCID: PMC5642983
DOI/URL:
Notes: Conference Paper -- Export Date: 5 September 2017 -- Source: Scopus
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MSK Authors
  1. Valerie W Rusch
    702 Rusch
  2. Li Cheng Kuo
    31 Kuo
  3. Andreas Rimner
    291 Rimner
  4. Andrew Jackson
    183 Jackson
  5. Ellen D Yorke
    334 Yorke
  6. Anthonia   Ojo
    2 Ojo