Dose-volume parameters predict for the development of chest wall pain after stereotactic body radiation for lung cancer Journal Article
| Authors: | Mutter, R. W.; Liu, F.; Abreu, A.; Yorke, E.; Jackson, A.; Rosenzweig, K. E. |
| Article Title: | Dose-volume parameters predict for the development of chest wall pain after stereotactic body radiation for lung cancer |
| Abstract: | Purpose: Chest wall (CW) pain has recently been recognized as an important adverse effect of stereotactic body radiation therapy (SBRT) for non-small-cell lung cancer (NSCLC). We developed a dose-volume model to predict the development of this toxicity. Methods and Materials: A total of 126 patients with primary, clinically node-negative NSCLC received three to five fractions of SBRT to doses of 40-60 Gy and were prospectively followed. The dose-absolute volume histograms of two different definitions of the CW as an organ at risk (CW3cm and CW2cm) were examined for all 126 patients. Results: With a median follow-up of 16 months, the 2-year estimated actuarial incidence of Grade ≥ 2 CW pain was 39%. The median time to onset of Grade ≥ 2 CW pain (National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0) was 9 months. There was no predictive advantage for biologically corrected dose over physical dose. Neither fraction number (p = 0.07) nor prescription dose (p = 0.07) were significantly correlated with the development of Grade ≥ 2 CW pain. Cox Proportional Hazards analysis identified significant correlation with a broad range of dose-volume combinations, with the CW volume receiving 30 Gy (V30) as one of the strongest predictors (p < 0.001). CW2cm consistently enabled better prediction of CW toxicity. When a physical dose of 30 Gy was received by more than 70 cm 3 of CW2cm, there was a significant correlation with Grade ≥ 2 CW pain (p = 0.004). Conclusions: CW toxicity after SBRT is common and long-term follow-up is needed to identify affected patients. A volume of CW ≥ 70 cm 3 receiving 30 Gy is significantly correlated with Grade ≥ 2 CW pain. We are currently applying this constraint at our institution for patients receiving thoracic SBRT. An actuarial atlas of our data is provided as an electronic supplement to facilitate data-sharing and meta-analysis relating to CW pain. © 2012 Elsevier Inc. |
| Keywords: | adult; aged; aged, 80 and over; middle aged; primary tumor; major clinical study; disease course; cancer localization; cancer radiotherapy; radiation dose; follow up; follow-up studies; prospective study; prospective studies; lung non small cell cancer; carcinoma, non-small-cell lung; lung neoplasms; proportional hazards models; radiotherapy; opiate; incidence; lung cancer; radiation injury; risk assessment; dose-response relationship, radiation; thorax pain; tumor burden; dosimetry; radiation dose fractionation; radiosurgery; lung; radiation injuries; forecasting; health; pain measurement; anticonvulsive agent; toxicity; dose fractionation; stereotactic body radiation therapy; fractures, bone; biological organs; thoracic wall; long-term follow-up; predictive value; histogram; meta-analysis; rib fracture; antiinflammatory agent; non small cell lung cancer; atlas; chest wall; dose-volume; proportional hazards; adverse effect; adverse events; topical anesthesia; drug products; common terminology criteria; national cancer institute; ribs; node-negative; organs at risk; dose-volume parameters; chest pain |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 82 |
| Issue: | 5 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2012-04-01 |
| Start Page: | 1783 |
| End Page: | 1790 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2011.03.053 |
| PUBMED: | 21868173 |
| PROVIDER: | scopus |
| PMCID: | PMC3580772 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 4 June 2012" - "CODEN: IOBPD" - "Source: Scopus" |
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