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Author Zhao, Jing ♦ Yorke, Ellen D. ♦ Li, Ling ♦ Kavanagh, Brian D. ♦ Li, X. Allen ♦ Das, Shiva ♦ Miften, Moyed ♦ Rimner, Andreas ♦ Campbell, Jeffrey ♦ Xue, Jinyu ♦ Jackson, Andrew ♦ Grimm, Jimm ♦ Milano, Michael T.
Source United States Department of Energy Office of Scientific and Technical Information
Content type Text
Language English
Subject Keyword RADIOLOGY AND NUCLEAR MEDICINE ♦ CHEST ♦ DOSIMETRY ♦ LUNGS ♦ NEOPLASMS ♦ PATIENTS ♦ RADIATION HAZARDS ♦ RADIOTHERAPY ♦ TOXICITY
Abstract Purpose: To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiation therapy (SBRT) of the thorax. Methods and Materials: Published studies on lung toxicity in patients with early-stage non–small cell lung cancer (NSCLC) or metastatic lung tumors treated with SBRT were pooled and analyzed. The primary endpoint was RILT, including pneumonitis and fibrosis. Data of RILT and risk factors were extracted from each study, and rates of grade 2 to 5 (G2+) and grade 3 to 5 (G3+) RILT were computed. Patient, tumor, and dosimetric factors were analyzed for their correlation with RILT. Results: Eighty-eight studies (7752 patients) that reported RILT incidence were eligible. The pooled rates of G2+ and G3+ RILT from all 88 studies were 9.1% (95% confidence interval [CI]: 7.15-11.4) and 1.8% (95% CI: 1.3-2.5), respectively. The median of median tumor sizes was 2.3 (range, 1.4-4.1) cm. Among the factors analyzed, older patient age (P=.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ (P=.049) and G3+ RILT (P=.001). Patients with stage IA versus stage IB NSCLC had significantly lower risks of G2+ RILT (8.3% vs 17.1%, odds ratio = 0.43, 95% CI: 0.29-0.64, P<.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) (P=.027) and V20 (P=.019) in patients with G2+ RILT than in those with grade 0 to 1 RILT. Conclusions: The overall rate of RILT is relatively low after thoracic SBRT. Older age and larger tumor size are significant adverse risk factors for RILT. Lung dosimetry, specifically lung V20 and MLD, also significantly affect RILT risk.
ISSN 03603016
Educational Use Research
Learning Resource Type Article
Publisher Date 2016-08-01
Publisher Place United States
Journal International Journal of Radiation Oncology, Biology and Physics
Volume Number 95
Issue Number 5


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