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Radiation-induced Pulmonary Toxicity: A Dose-volume Histogram Analysis In 201 Patients With Lung Cancer.

M. L. Hernando, L. Marks, G. Bentel, S. Zhou, D. Hollis, S. Das, M. Fan, M. Munley, T. Shafman, M. Anscher, P. Lind
Published 2001 · Medicine

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PURPOSE To relate lung dose-volume histogram-based factors to symptomatic radiation pneumonitis (RP) in patients with lung cancer undergoing 3-dimensional (3D) radiotherapy planning. METHODS AND MATERIALS Between 1991 and 1999, 318 patients with lung cancer received external beam radiotherapy (RT) with 3D planning tools at Duke University Medical Center. One hundred seventeen patients were not evaluated for RP because of <6 months of follow-up, development of progressive intrathoracic disease making scoring of pulmonary symptoms difficult, or unretrievable 3D dosimetry data. Thus, 201 patients were analyzed for RP. Univariate and multivariate analyses were performed to test the association between RP and dosimetric factors (i.e., mean lung dose, volume of lung receiving >or=30 Gy, and normal tissue complication probability derived from the Lyman and Kutcher models) and clinical factors, including tobacco use, age, sex, chemotherapy exposure, tumor site, pre-RT forced expiratory volume in 1 s, weight loss, and performance status. RESULTS Thirty-nine patients (19%) developed RP. In the univariate analysis, all dosimetric factors (i.e., mean lung dose, volume of lung receiving >or=30 Gy, and normal tissue complication probability) were associated with RP (p range 0.006-0.003). Of the clinical factors, ongoing tobacco use at the time of referral for RT was associated with fewer cases of RP (p = 0.05). These factors were also independently associated with RP according to the multivariate analysis (p = 0.001). Models predictive for RP based on dosimetric factors only, or on a combination with the influence of tobacco use, had a concordance of 64% and 68%, respectively. CONCLUSIONS Dosimetric factors were the best predictors of symptomatic RP after external beam RT for lung cancer. Multivariate models that also include clinical variables were slightly more predictive.
This paper references
10.1118/1.597056
Probability of radiation-induced complications for normal tissues with parallel architecture subject to non-uniform irradiation.
A. Jackson (1993)
10.1016/0360-3016(89)90462-8
Optimization of radiation therapy, IV: A dose-volume histogram reduction algorithm.
J. Lyman (1989)
Phase I/IIa study of concurrent paclitaxel and cisplatin with radiation therapy in locally advanced non-small cell lung cancer: analysis of early and late pulmonary morbidity.
F. Robert (1999)
10.2307/3583506
Complication probability as assessed from dose-volume histograms.
J. Lyman (1985)
10.1016/S0959-8049(97)00377-8
Risk factors of pneumonitis following chemoradiotherapy for lung cancer.
M. Yamada (1998)
10.1016/S0360-3016(96)00353-7
High-dose, hyperfractionated, accelerated radiotherapy using a concurrent boost for the treatment of nonsmall cell lung cancer: unusual toxicity and promising early results.
S. C. King (1996)
10.1016/0958-3947(91)90120-Q
Positioning and immobilization of patients undergoing radiation therapy for Hodgkin's disease.
G. Bentel (1991)
10.1016/0360-3016(95)00009-N
Estimation of pneumonitis risk in three-dimensional treatment planning using dose-volume histogram analysis.
D. Oetzel (1995)
10.1016/0360-3016(93)90377-8
The influence of field size and other treatment factors on pulmonary toxicity following hyperfractionated irradiation for inoperable non-small cell lung cancer (NSCLC)-analysis of a radiation therapy oncology group (RTOG) protocol
R. Byhardt (1993)
10.1016/S0360-3016(99)00183-2
Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC)
M. Graham (1999)
Radiation-induced increase in hyaluronan and fibronectin in bronchoalveolar lavage fluid from breast cancer patients is suppressed by smoking.
L. Bjermer (1992)
10.1016/S0360-3016(96)00275-1
Uncertainties in CT-based radiation therapy treatment planning associated with patient breathing.
J. Balter (1996)
10.1016/S0360-3016(00)00648-9
Factors predicting severe radiation pneumonitis in patients receiving definitive chemoradiation for lung cancer.
T. J. Robnett (2000)
10.1200/JCO.1986.4.2.200
Pulmonary toxicity with combined modality therapy for limited stage small-cell lung cancer.
B. Brooks (1986)
10.1016/0360-3016(89)90972-3
Calculation of complication probability factors for non-uniform normal tissue irradiation: the effective volume method.
G. Kutcher (1989)
10.1080/095530000138466
Radiation-induced pulmonary injury: symptomatic versus subclinical endpoints.
L. Marks (2000)
10.1016/0360-3016(93)90156-P
Modeling of normal tissue response to radiation: the critical volume model.
A. Niemierko (1993)
10.1016/S0360-3016(98)00373-3
The influence of age on the delivery, tolerance, and efficacy of thoracic irradiation in the combined modality treatment of limited stage small cell lung cancer.
H. Quon (1999)
10.1016/0360-3016(94)90181-3
Dose-volume histogram and 3-D treatment planning evaluation of patients with pneumonitis.
M. Martel (1994)
10.1148/129.3.787
The equivalent tissue-air ratio method for making absorbed dose calculations in a heterogeneous medium.
M. Sontag (1978)
10.1016/0360-3016(78)90189-X
Smoking: the influence of carboxyhemoglobin (HbCO) on tumor oxygenation and response to radiation.
D. Siemann (1978)
10.1016/S0360-3016(98)00196-5
Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients.
S. L. Kwa (1998)
10.1200/JCO.1995.13.10.2606
Radiation pneumonitis following combined modality therapy for lung cancer: analysis of prognostic factors.
M. Roach (1995)
10.1016/0360-3016(92)90845-9
Influence of carboxyhemoglobin level on tumor growth, blood flow, and radiation response in an experimental model.
C. Grau (1992)
10.1200/JCO.2001.19.3.705
73.6 Gy and beyond: hyperfractionated, accelerated radiotherapy for non-small-cell lung cancer.
P. D. Maguire (2001)
10.1016/0360-3016(91)90032-Y
Virtual simulation: initial clinical results.
J. Rosenman (1991)
10.1200/JCO.1996.14.4.1065
Hyperfractionated radiation therapy with or without concurrent low-dose daily carboplatin/etoposide for stage III non-small-cell lung cancer: a randomized study.
B. Jeremic (1996)
10.1056/NEJM199301213280302
Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer.
G. Browman (1993)
10.1016/S0360-3016(99)00154-6
Deep inspiration breath-hold technique for lung tumors: the potential value of target immobilization and reduced lung density in dose escalation.
J. Hanley (1999)
10.1016/S0360-3016(98)00386-1
Computerized design of target margins for treatment uncertainties in conformal radiotherapy.
G. Mageras (1999)
10.1093/OXFORDJOURNALS.ANNONC.A059286
Strategy for dose escalation using 3-dimensional conformal radiation therapy for lung cancer.
J. Armstrong (1995)
10.1016/0167-8140(91)90068-R
The simultaneous boost technique: the concept of relative normalized total dose.
J. Lebesque (1991)
10.1259/0007-1285-43-509-349
Experimental tests of corrections for tissue inhomogeneities in radiotherapy.
M. E. Young (1970)
10.1016/0167-8140(93)90264-9
Probability of radiation-induced complications in normal tissues with parallel architecture under conditions of uniform whole or partial organ irradiation.
E. Yorke (1993)
10.1016/1053-4296(92)90024-F
Treatment Planning at the University of North Carolina at Chapel Hill.
Sailer (1992)
10.1016/S0360-3016(00)80117-0
Changes in plasma transforming growth factor β1 during radiotherapy: an independent predictor of radiation pneumonitis
X. Fu (2000)
10.1016/0360-3016(94)90213-5
Optimization of radiation therapy
A. Brahme (1994)
10.1056/NEJM199202203260805
Effects of concomitant cisplatin and radiotherapy on inoperable non-small-cell lung cancer.
C. Schaake-Koning (1992)
10.1200/JCO.1996.14.4.1055
Concurrent chemoradiation therapy with oral etoposide and cisplatin for locally advanced inoperable non-small-cell lung cancer: radiation therapy oncology group protocol 91-06.
J. S. Lee (1996)
10.1016/S0167-8140(98)00064-4
Effects of ongoing smoking on the development of radiation-induced pneumonitis in breast cancer and oesophagus cancer patients.
S. Johansson (1998)
10.1016/S0360-3016(98)00251-X
Response, toxicity, failure patterns, and survival in five Radiation Therapy Oncology Group (RTOG) trials of sequential and/or concurrent chemotherapy and radiotherapy for locally advanced non-small-cell carcinoma of the lung.
R. Byhardt (1998)
10.1378/CHEST.82.5.526
Reversible alterations in immunoregulatory T cells in smoking. Analysis by monoclonal antibodies and flow cytometry.
L. Miller (1982)



This paper is referenced by
10.1088/0031-9155/54/8/022
Comparison of PDR brachytherapy and external beam radiation therapy in the case of breast cancer.
L Teymournia (2009)
10.1053/j.semnuclmed.2010.07.005
SPECT/CT in V/Q scanning.
P. Roach (2010)
10.1118/1.3005974
A genetic algorithm for variable selection in logistic regression analysis of radiotherapy treatment outcomes.
O. Gayou (2008)
10.1016/J.HOC.2003.12.007
Toxicity of small cell lung cancer treatment.
F. Casas (2004)
10.1097/PCR.0B013E3182920613
End-Stage Radiation Pneumonitis After Autologous Stem Cell Transplantation for Refractory Hodgkin Lymphoma: Pathologic Findings of Explanted Native Lungs
Daniel J Fix (2013)
10.1016/j.radonc.2007.12.010
Evaluating target coverage and normal tissue sparing in the adjuvant radiotherapy of malignant pleural mesothelioma: helical tomotherapy compared with step-and-shoot IMRT.
F. Sterzing (2008)
10.1007/s13566-012-0079-y
The role of lung lobes in radiation pneumonitis and radiation-induced inflammation in the lung: a retrospective study
M. McCurdy (2012)
10.1016/J.IJROBP.2007.06.075
Restricted field IMRT dramatically enhances IMRT planning for mesothelioma.
A. Allen (2007)
10.1016/j.radonc.2015.08.013
Assessing radiation exposure of the left anterior descending artery, heart and lung in patients with left breast cancer: A dosimetric comparison between multicatheter accelerated partial breast irradiation and whole breast external beam radiotherapy.
T. Y. Chan (2015)
10.1016/j.radonc.2009.12.022
Real-time dynamic MLC tracking for inversely optimized arc radiotherapy.
M. Falk (2010)
10.1097/COC.0b013e3181d6b40f
Chemotherapy Significantly Increases the Risk of Radiation Pneumonitis in Radiation Therapy of Advanced Lung Cancer
B. Parashar (2011)
10.1186/s13014-019-1276-2
Changes of lung parenchyma density following high dose radiation therapy for thoracic carcinomas – an automated analysis of follow up CT scans
C. Schröder (2019)
10.1016/j.radphyschem.2020.108957
An efficient treatment planning approach to reduce the critical organ dose in volumetric modulated arc therapy for synchronous bilateral breast cancer patients
Y. Lin (2020)
10.1016/j.ijrobp.2008.02.057
Irradiation of varying volumes of rat lung to same mean lung dose: a little to a lot or a lot to a little?
V. Semenenko (2008)
NCCN Guidelines Version 1.2015 Panel Members Non-Small Cell Lung Cancer
David S. Ettinger (2014)
10.1016/S0360-3016(02)03807-5
Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer.
K. Tsujino (2003)
10.1177/030089161209800109
Radiotherapy in Italy for Non-Small Cell Lung Cancer: Patterns of Care Survey
S. Ramella (2012)
10.1007/S12094-007-0094-4
Toxicity associated to radiotherapy treatment in lung cancer patients.
M. L. Rodríguez (2007)
The Management of Respiratory Motion in Radiation Oncology Handout for AAPM 2005 Continuing Education Session, based on the
P. Keall (2005)
10.4236/IJMPCERO.2013.23013
Effect of Breathing on Exposed Lung Volumes and Doses in Patients with Breast Carcinoma Receiving Radiotherapy
E. Goksel (2013)
10.1016/J.RADONC.2004.01.019
Transforming growth factor-beta plasma dynamics and post-irradiation lung injury in lung cancer patients.
Alena Novakova-Jiresova (2004)
10.1016/J.IJROBP.2006.07.1337
Analysis of clinical and dosimetric factors associated with treatment-related pneumonitis (TRP) in patients with non-small-cell lung cancer (NSCLC) treated with concurrent chemotherapy and three-dimensional conformal radiotherapy (3D-CRT).
S. Wang (2006)
10.1097/JTO.0b013e3181ce3e00
Efficacy and Toxicity of Chemoradiotherapy with Carboplatin and Irinotecan Followed by Consolidation Docetaxel for Unresectable Stage III Non-small Cell Lung Cancer
B. R. Bastos (2010)
10.1700/1053.11502
Radiotherapy in Italy for non-small cell lung cancer: patterns of care survey.
S. Ramella (2012)
10.1007/978-0-387-36744-6_11
Image-based modeling of normal tissue complication probability for radiation therapy.
J. Deasy (2008)
10.1259/bjr.20140612
Use of tomotherapy in treatment of synchronous bilateral breast cancer: dosimetric comparison study.
T. Wadasadawala (2015)
10.1016/j.lpm.2013.06.012
Complications of thoracic radiotherapy.
Cyrus Chargari (2013)
10.1007/s00066-008-1877-4
Effects of Smoking Cessation on Hypoxia and its Potential Impact on Radiation Treatment Effects in Lung Cancer Patients
C. Nieder (2008)
10.1016/J.PNEUMO.2014.11.009
Le tabac et ses conséquences dans le cadre du traitement du cancer bronchique
Caroline Rivera (2016)
10.1007/978-94-007-0489-3_10
The Risks of Breast Radiotherapy and How to Avoid Them
Z. Kahán (2011)
10.1007/s12094-012-0848-5
Toxicity of concurrent hyperfractionated radiation therapy and chemotherapy in locally advanced (stage III) non-small cell lung cancer (NSCLC): single institution experience in 600 patients
B. Jeremić (2012)
10.1097/01.coc.0000260950.44761.74
Can Serum Markers Be Used to Predict Acute and Late Toxicity in Patients With Lung Cancer?: Analysis of RTOG 91-03
W. Hartsell (2007)
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