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Title: Radiation-Induced Rib Fractures After Hypofractionated Stereotactic Body Radiation Therapy: Risk Factors and Dose-Volume Relationship

Abstract

Purpose: The purpose of this study was to clarify the incidence, the clinical risk factors, and the dose-volume relationship of radiation-induced rib fracture (RIRF) after hypofractionated stereotactic body radiation therapy (SBRT). Methods and Materials: One hundred sixteen patients treated with SBRT for primary or metastatic lung cancer at our institution, with at least 6 months of follow-up and no previous overlapping radiation exposure, were included in this study. To determine the clinical risk factors associated with RIRF, correlations between the incidence of RIRF and the variables, including age, sex, diagnosis, gross tumor volume diameter, rib-tumor distance, and use of steroid administration, were analyzed. Dose-volume histogram analysis was also conducted. Regarding the maximum dose, V10, V20, V30, and V40 of the rib, and the incidences of RIRF were compared between the two groups divided by the cutoff value determined by the receiver operating characteristic curves. Results: One hundred sixteen patients and 374 ribs met the inclusion criteria. Among the 116 patients, 28 patients (46 ribs) experienced RIRF. The estimated incidence of rib fracture was 37.7% at 3 years. Limited distance from the rib to the tumor (<2.0 cm) was the only significant risk factor for RIRF (p = 0.0001). Among themore » dosimetric parameters used for receiver operating characteristic analysis, the maximum dose showed the highest area under the curve. The 3-year estimated risk of RIRF and the determined cutoff value were 45.8% vs. 1.4% (maximum dose, {>=}42.4 Gy or less), 51.6% vs. 2.0% (V40, {>=}0.29 cm{sup 3} or less), 45.8% vs. 2.2% (V30, {>=}1.35 cm{sup 3} or less), 42.0% vs. 8.5% (V20, {>=}3.62 cm{sup 3} or less), or 25.9% vs. 10.5% (V10, {>=}5.03 cm{sup 3} or less). Conclusions: The incidence of RIRF after hypofractionated SBRT is relatively high. The maximum dose and high-dose volume are strongly correlated with RIRF.« less

Authors:
 [1];  [2]; ; ; ;  [1];  [2];  [3]; ;  [1];  [4];  [1]
  1. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)
  2. Department of Heavy Particle Therapy and Radiation Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)
  3. Department of Radiology, National Center for Global Health and Medicine, Tokyo (Japan)
  4. Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)
Publication Date:
OSTI Identifier:
22149590
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 3; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CORRELATIONS; DIAGNOSIS; FRACTURES; HEALTH HAZARDS; LUNGS; METASTASES; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SEX; STEROIDS

Citation Formats

Asai, Kaori, Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp, Nakamura, Katsumasa, Sasaki, Tomonari, Ohga, Saiji, Nonoshita, Takeshi, Yoshitake, Tadamasa, Ohnishi, Kayoko, Terashima, Kotaro, Matsumoto, Keiji, Hirata, Hideki, and Honda, Hiroshi. Radiation-Induced Rib Fractures After Hypofractionated Stereotactic Body Radiation Therapy: Risk Factors and Dose-Volume Relationship. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.01.027.
Asai, Kaori, Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp, Nakamura, Katsumasa, Sasaki, Tomonari, Ohga, Saiji, Nonoshita, Takeshi, Yoshitake, Tadamasa, Ohnishi, Kayoko, Terashima, Kotaro, Matsumoto, Keiji, Hirata, Hideki, & Honda, Hiroshi. Radiation-Induced Rib Fractures After Hypofractionated Stereotactic Body Radiation Therapy: Risk Factors and Dose-Volume Relationship. United States. doi:10.1016/J.IJROBP.2012.01.027.
Asai, Kaori, Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp, Nakamura, Katsumasa, Sasaki, Tomonari, Ohga, Saiji, Nonoshita, Takeshi, Yoshitake, Tadamasa, Ohnishi, Kayoko, Terashima, Kotaro, Matsumoto, Keiji, Hirata, Hideki, and Honda, Hiroshi. Thu . "Radiation-Induced Rib Fractures After Hypofractionated Stereotactic Body Radiation Therapy: Risk Factors and Dose-Volume Relationship". United States. doi:10.1016/J.IJROBP.2012.01.027.
@article{osti_22149590,
title = {Radiation-Induced Rib Fractures After Hypofractionated Stereotactic Body Radiation Therapy: Risk Factors and Dose-Volume Relationship},
author = {Asai, Kaori and Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp and Nakamura, Katsumasa and Sasaki, Tomonari and Ohga, Saiji and Nonoshita, Takeshi and Yoshitake, Tadamasa and Ohnishi, Kayoko and Terashima, Kotaro and Matsumoto, Keiji and Hirata, Hideki and Honda, Hiroshi},
abstractNote = {Purpose: The purpose of this study was to clarify the incidence, the clinical risk factors, and the dose-volume relationship of radiation-induced rib fracture (RIRF) after hypofractionated stereotactic body radiation therapy (SBRT). Methods and Materials: One hundred sixteen patients treated with SBRT for primary or metastatic lung cancer at our institution, with at least 6 months of follow-up and no previous overlapping radiation exposure, were included in this study. To determine the clinical risk factors associated with RIRF, correlations between the incidence of RIRF and the variables, including age, sex, diagnosis, gross tumor volume diameter, rib-tumor distance, and use of steroid administration, were analyzed. Dose-volume histogram analysis was also conducted. Regarding the maximum dose, V10, V20, V30, and V40 of the rib, and the incidences of RIRF were compared between the two groups divided by the cutoff value determined by the receiver operating characteristic curves. Results: One hundred sixteen patients and 374 ribs met the inclusion criteria. Among the 116 patients, 28 patients (46 ribs) experienced RIRF. The estimated incidence of rib fracture was 37.7% at 3 years. Limited distance from the rib to the tumor (<2.0 cm) was the only significant risk factor for RIRF (p = 0.0001). Among the dosimetric parameters used for receiver operating characteristic analysis, the maximum dose showed the highest area under the curve. The 3-year estimated risk of RIRF and the determined cutoff value were 45.8% vs. 1.4% (maximum dose, {>=}42.4 Gy or less), 51.6% vs. 2.0% (V40, {>=}0.29 cm{sup 3} or less), 45.8% vs. 2.2% (V30, {>=}1.35 cm{sup 3} or less), 42.0% vs. 8.5% (V20, {>=}3.62 cm{sup 3} or less), or 25.9% vs. 10.5% (V10, {>=}5.03 cm{sup 3} or less). Conclusions: The incidence of RIRF after hypofractionated SBRT is relatively high. The maximum dose and high-dose volume are strongly correlated with RIRF.},
doi = {10.1016/J.IJROBP.2012.01.027},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}