Impact of fractionation and dose in a multivariate model for radiation-induced chest wall pain Journal Article
| Authors: | Din, S. U.; Williams, E. L.; Jackson, A.; Rosenzweig, K. E.; Wu, A. J.; Foster, A.; Yorke, E. D.; Rimner, A. |
| Article Title: | Impact of fractionation and dose in a multivariate model for radiation-induced chest wall pain |
| Abstract: | Purpose To determine the role of patient/tumor characteristics, radiation dose, and fractionation using the linear-quadratic (LQ) model to predict stereotactic body radiation therapy-induced grade ≥2 chest wall pain (CWP2) in a larger series and develop clinically useful constraints for patients treated with different fraction numbers. Methods and Materials A total of 316 lung tumors in 295 patients were treated with stereotactic body radiation therapy in 3 to 5 fractions to 39 to 60 Gy. Absolute dose-absolute volume chest wall (CW) histograms were acquired. The raw dose-volume histograms (α/β = ∞ Gy) were converted via the LQ model to equivalent doses in 2-Gy fractions (normalized total dose, NTD) with α/β from 0 to 25 Gy in 0.1-Gy steps. The Cox proportional hazards (CPH) model was used in univariate and multivariate models to identify and assess CWP2 exposed to a given physical and NTD. Results The median follow-up was 15.4 months, and the median time to development of CWP2 was 7.4 months. On a univariate CPH model, prescription dose, prescription dose per fraction, number of fractions, D83cc, distance of tumor to CW, and body mass index were all statistically significant for the development of CWP2. Linear-quadratic correction improved the CPH model significance over the physical dose. The best-fit α/β was 2.1 Gy, and the physical dose (α/β = ∞ Gy) was outside the upper 95% confidence limit. With α/β = 2.1 Gy, V<inf>NTD99Gy</inf> was most significant, with median V<inf>NTD99Gy</inf> = 31.5 cm3 (hazard ratio 3.87, P<.001). Conclusion There were several predictive factors for the development of CWP2. The LQ-adjusted doses using the best-fit α/β = 2.1 Gy is a better predictor of CWP2 than the physical dose. To aid dosimetrists, we have calculated the physical dose equivalent corresponding to V<inf>NTD99Gy</inf> = 31.5 cm3 for the 3- to 5-fraction groups. © 2015 Elsevier Inc. All rights reserved. |
| Keywords: | adult; aged; major clinical study; radiation dose; follow up; radiotherapy; patient monitoring; body mass; thorax pain; tumors; dosimetry; radiation dose fractionation; patient treatment; stereotactic body radiation therapy; histogram; non small cell lung cancer; predictive factors; proportional hazards; graphic methods; linear-quadratic models; hazards; dose-volume histograms; methods and materials; human; male; female; priority journal; article; multivariate modeling; multivariate models; chest wall pain |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 93 |
| Issue: | 2 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2015-10-01 |
| Start Page: | 418 |
| End Page: | 424 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2015.06.014 |
| PROVIDER: | scopus |
| PUBMED: | 26254680 |
| PMCID: | PMC4886343 |
| DOI/URL: | |
| Notes: | Presented at the 55th Annual Meeting of the American Society for Radiation Oncology; 2013 Sep 22-25; Atlanta, GA -- Export Date: 2 October 2015 -- Source: Scopus |
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