Clinical and dosimetric risk factors associated with radiation-induced lung toxicities after multiple courses of lung stereotactic body radiation therapy Journal Article
| Authors: | Li, X.; Yorke, E.; Jackson, A.; Yue, Y.; Simone, C. B. 2nd; Apte, A. P.; Rimner, A.; Gomez, D. R.; Shaverdian, N.; Gelblum, D. Y.; Wu, A. J.; Shepherd, A. F. |
| Article Title: | Clinical and dosimetric risk factors associated with radiation-induced lung toxicities after multiple courses of lung stereotactic body radiation therapy |
| Abstract: | Purpose: Data are limited on radiation-induced lung toxicities (RILT) after multiple courses of lung stereotactic body radiation therapy (SBRT). We herein analyze a large cohort of patients to explore the clinical and dosimetric risk factors associated with RILT in such settings. Methods and Materials: A single institutional database of patients treated with multiple courses of lung SBRT between January 2014 and December 2019 was analyzed. Grade 2 or higher (G2+) RILT after the last course of SBRT was the primary endpoint. Composite plans were generated with advanced algorithms including deformable registration and equivalent dose adjustment. Logistic regression analyses were performed to examine correlations between patient or treatment factors including dosimetry and G2+ RILT. Risk stratification of patients and lung constraints based on acceptable normal tissue complication probability were calculated based on risk factors identified. Results: Among 110 eligible patients (56 female and 54 male), there were 64 synchronous (58.2%; defined as 2 courses of SBRT delivered within 30 days) and 46 metachronous (41.8%) courses of SBRT. The composite median lung V20, lung V5, and mean lung dose were 9.9% (interquartile range [IQR], 7.3%-12.4%), 32.2% (IQR, 25.5%-40.1%), and 7.0 Gy (IQR, 5.5 Gy-8.6 Gy), respectively. With a median follow-up of 21.1 months, 30 patients (27.3%) experienced G2+ RILT. Five patients (4.5%) developed G3 RILT, and 1 patient (0.9%) developed G4 RILT, and no patients developed G5 RILT. On multivariable regression analysis, female sex (odds ratio [OR], 4.35; 95% CI, 1.49%-14.3%; P = .01), synchronous SBRT (OR, 8.78; 95% CI, 2.27%-47.8%; P = .004), prior G2+ RILT (OR, 29.8; 95% CI, 2.93%-437%; P = .007) and higher composite lung V20 (OR, 1.18; 95% CI, 1.02%-1.38%; P = .030) were associated with significantly higher likelihood of G2+ RILT. Conclusions: Our data suggest an acceptable incidence of G2+ RILT after multiple courses of lung SBRT. Female sex, synchronous SBRT, prior G2+ RILT, and higher composite lung V20 may be risk factors for G2+ RILT. © 2023 The Authors |
| Keywords: | cancer chemotherapy; controlled study; aged; antibiotic agent; major clinical study; cancer recurrence; intensity modulated radiation therapy; systemic therapy; gemcitabine; paclitaxel; cancer radiotherapy; follow up; lung toxicity; radiotherapy dosage; oxygen therapy; cohort analysis; lung cancer; steroid; risk factor; high risk patient; lung metastasis; karnofsky performance status; dosimetry; radiation dose fractionation; sex difference; second cancer; lung surgery; stereotactic body radiation therapy; multiple cancer; radiation pneumonia; chronic obstructive lung disease; cone beam computed tomography; volumetric modulated arc therapy; steroid therapy; non small cell lung cancer; clinical target volume; lung parenchyma; re-irradiation; low risk patient; dose volume histogram; planning target volume; hospital acquired pneumonia; four dimensional computed tomography; human; male; female; article; ex-smoker; deformable registration algorithm; home oxygen therapy |
| Journal Title: | Advances in Radiation Oncology |
| Volume: | 9 |
| Issue: | 1 |
| ISSN: | 2452-1094 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-01-01 |
| Start Page: | 101284 |
| Language: | English |
| DOI: | 10.1016/j.adro.2023.101284 |
| PROVIDER: | scopus |
| PMCID: | PMC10801636 |
| PUBMED: | 38260213 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Xingzhe Li -- Source: Scopus |
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