Chest Wall Volume Receiving >30 Gy Predicts Risk of Severe Pain and/or Rib Fracture After Lung Stereotactic Body Radiotherapy

Journal Article · Mon Mar 01 04:00:00 EST 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.02.027· OSTI ID:21372103

Dunlap, Neal E; Cai, Jing; Biedermann, Gregory B; Yang, Wensha; Benedict, Stanley H; Ke, Sheng ^[1]; Schefter, Tracey E; Kavanagh, Brian D ^[2]

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1. University of Virginia, Charlottesville, VA (United States)
2. University of Colorado Denver, Aurora, CO (United States)

Purpose: To identify the dose-volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy. Methods and Materials: From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving >=20, >=30, >=40, >=50, and >=60 Gy was determined and related to the risk of CW toxicity. Results: Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose-response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R{sup 2} = 0.9552). A volume threshold of 30 cm{sup 3} was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm{sup 3} receiving 30 Gy. Conclusion: The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to <30 cm{sup 3}, if possible, to reduce the risk of toxicity without compromising tumor coverage.

• OSTI ID: 21372103
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 76; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BODY
CHEST
FAILURES
FRACTURES
HAZARDS
HEALTH HAZARDS
LUNGS
MEDICINE
NUCLEAR MEDICINE
ORGANS
PAIN
PLANNING
RADIOLOGY
RADIOTHERAPY
RESPIRATORY SYSTEM
SYMPTOMS
THERAPY
TOXICITY
WALLS