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Title: Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies

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 providedmore » 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.« less

Authors:
 [1];  [2];  [3];  [1];  [2];  [4];  [5];  [6];  [4];  [7];  [1];  [8];  [3];  [9];  [10];
  1. Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, Georgia (United States)
  2. (China)
  3. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States)
  4. Department of Radiation Oncology, University of Colorado, Denver, Colorado (United States)
  5. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States)
  6. Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)
  7. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York (United States)
  8. Department of Radiation Oncology, MD Anderson Cancer Center at Cooper, Camden, New Jersey (United States)
  9. Bott Cancer Center, Holy Redeemer Hospital, Meadowbrook, Pennsylvania (United States)
  10. Department of Radiation Oncology, University of Rochester, Rochester, New York (United States)
Publication Date:
OSTI Identifier:
22648754
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 95; Journal Issue: 5; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEST; DOSIMETRY; LUNGS; NEOPLASMS; PATIENTS; RADIATION HAZARDS; RADIOTHERAPY; TOXICITY

Citation Formats

Zhao, Jing, Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Yorke, Ellen D., Li, Ling, Department of Shanghai Cancer Hospital, Fudan University, Shanghai, Kavanagh, Brian D., Li, X. Allen, Das, Shiva, Miften, Moyed, Rimner, Andreas, Campbell, Jeffrey, Xue, Jinyu, Jackson, Andrew, Grimm, Jimm, Milano, Michael T., and and others. Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies. United States: N. p., 2016. Web. doi:10.1016/J.IJROBP.2016.03.024.
Zhao, Jing, Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Yorke, Ellen D., Li, Ling, Department of Shanghai Cancer Hospital, Fudan University, Shanghai, Kavanagh, Brian D., Li, X. Allen, Das, Shiva, Miften, Moyed, Rimner, Andreas, Campbell, Jeffrey, Xue, Jinyu, Jackson, Andrew, Grimm, Jimm, Milano, Michael T., & and others. Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies. United States. doi:10.1016/J.IJROBP.2016.03.024.
Zhao, Jing, Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Yorke, Ellen D., Li, Ling, Department of Shanghai Cancer Hospital, Fudan University, Shanghai, Kavanagh, Brian D., Li, X. Allen, Das, Shiva, Miften, Moyed, Rimner, Andreas, Campbell, Jeffrey, Xue, Jinyu, Jackson, Andrew, Grimm, Jimm, Milano, Michael T., and and others. Mon . "Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies". United States. doi:10.1016/J.IJROBP.2016.03.024.
@article{osti_22648754,
title = {Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies},
author = {Zhao, Jing and Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan and Yorke, Ellen D. and Li, Ling and Department of Shanghai Cancer Hospital, Fudan University, Shanghai and Kavanagh, Brian D. and Li, X. Allen and Das, Shiva and Miften, Moyed and Rimner, Andreas and Campbell, Jeffrey and Xue, Jinyu and Jackson, Andrew and Grimm, Jimm and Milano, Michael T. and and others},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2016.03.024},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 95,
place = {United States},
year = {Mon Aug 01 00:00:00 EDT 2016},
month = {Mon Aug 01 00:00:00 EDT 2016}
}