Obesity Increases the Risk of Chest Wall Pain From Thoracic Stereotactic Body Radiation Therapy

Journal Article · Thu Sep 01 04:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.04.022· OSTI ID:21587695

Welsh, James ^[1]; Thomas, Jimmy; Shah, Deep; Allen, Pamela K; Wei, Xiong; Mitchell, Kevin ^[1]; Gao, Song; Balter, Peter ^[2]; Komaki, Ritsuko; Chang, Joe Y ^[1]

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1. Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
2. Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

Purpose: Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. Patients and Methods: We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0. Results: Of 360 patients in the database, 265 (268 tumors) had tumors within <2.5 cm of the chest wall; 104 (39%) developed skin toxicity (any grade); 14 (5%) developed acute pain (any grade), and 45 (17%) developed chronic pain (Grade 1 in 22 cases [49%] and Grade 2 or 3 in 23 cases [51%]). Both skin toxicity and chest wall pain were associated with the V{sub 30}, or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI {>=}29 had almost twice the risk of chronic pain (p = 0.03). Among patients with BMI >29, diabetes mellitus was a significant contributing factor to the development of chest pain. Conclusion: Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.

• OSTI ID: 21587695
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 81; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BODY
CHEST
DIABETES MELLITUS
DISEASES
DOSES
ENDOCRINE DISEASES
HAZARDS
MEDICINE
METABOLIC DISEASES
NEOPLASMS
NUCLEAR MEDICINE
ORGANS
PAIN
RADIATION DOSES
RADIOLOGY
RADIOTHERAPY
SKIN
SYMPTOMS
THERAPY
TOXICITY