Online citations, reference lists, and bibliographies.
← Back to Search

Radiation Pneumonitis As A Function Of Mean Lung Dose: An Analysis Of Pooled Data Of 540 Patients.

S. L. Kwa, J. Lebesque, J. Theuws, L. Marks, M. Munley, G. Bentel, D. Oetzel, U. Spahn, M. Graham, R. Drzymala, J. Purdy, A. Lichter, M. Martel, R. Ten Haken
Published 1998 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
PURPOSE To determine the relation between the incidence of radiation pneumonitis and the three-dimensional dose distribution in the lung. METHODS AND MATERIALS In five institutions, the incidence of radiation pneumonitis was evaluated in 540 patients. The patients were divided into two groups: a Lung group, consisting of 399 patients with lung cancer and 1 esophagus cancer patient and a Lymph./Breast group with 78 patients treated for malignant lymphoma, 59 for breast cancer, and 3 for other tumor types. The dose per fraction varied between 1.0 and 2.7 Gy and the prescribed total dose between 20 and 92 Gy. Three-dimensional dose calculations were performed with tissue density inhomogeneity correction. The physical dose distribution was converted into the biologically equivalent dose distribution given in fractions of 2 Gy, the normalized total dose (NTD) distribution, by using the linear quadratic model with an alpha/beta ratio of 2.5 and 3.0 Gy. Dose-volume histograms (DVHs) were calculated considering both lungs as one organ and from these DVHs the mean (biological) lung dose, NTDmean, was obtained. Radiation pneumonitis was scored as a complication when the pneumonitis grade was grade 2 (steroids needed for medical treatment) or higher. For statistical analysis the conventional normal tissue complication probability (NTCP) model of Lyman (with n=1) was applied along with an institutional-dependent offset parameter to account for systematic differences in scoring patients at different institutions. RESULTS The mean lung dose, NTDmean, ranged from 0 to 34 Gy and 73 of the 540 patients experienced pneumonitis, grade 2 or higher. In all centers, an increasing pneumonitis rate was observed with increasing NTDmean. The data were fitted to the Lyman model with NTD50=31.8 Gy and m=0.43, assuming that for all patients the same parameter values could be used. However, in the low dose range at an NTDmean between 4 and 16 Gy, the observed pneumonitis incidence in the Lung group (10%) was significantly (p=0.02) higher than in the Lymph./Breast group (1.4%). Moreover, between the Lung groups of different institutions, also significant (p=0.04) differences were present: for centers 2, 3, and 4, the pneumonitis incidence was about 13%, whereas for center 5 only 3%. Explicitly accounting for these differences by adding center-dependent offset values for the Lung group, improved the data fit significantly (p < 10(-5)) with NTD50=30.5+/-1.4 Gy and m=0.30+/-0.02 (+/-1 SE) for all patients, and an offset of 0-11% for the Lung group, depending on the center. CONCLUSIONS The mean lung dose, NTDmean, is relatively easy to calculate, and is a useful predictor of the risk of radiation pneumonitis. The observed dose-effect relation between the NTDmean and the incidence of radiation pneumonitis, based on a large clinical data set, might be of value in dose-escalating studies for lung cancer. The validity of the obtained dose-effect relation will have to be tested in future studies, regarding the influence of confounding factors and dose distributions different from the ones in this study.
This paper references
10.1016/0167-8140(89)90009-1
Radiation-induced lung damage: dose-time fractionation considerations.
J. Fowler (1990)
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/S0167-8140(86)80061-5
Alpha/beta value and the importance of size of dose per fraction for late complications in the supraglottic larynx.
B. Maciejewski (1986)
10.1016/0169-5002(91)90388-M
Radiation-induced lung injury. From the chest physician's point of view
P. Maasilta (1991)
10.1016/0167-8140(93)90026-5
Evaluation of isoeffect formulae for predicting radiation-induced lung damage.
C. Newcomb (1993)
10.1016/0167-8140(91)90068-R
The simultaneous boost technique: the concept of relative normalized total dose.
J. Lebesque (1991)
10.1016/0360-3016(91)90172-Z
Fitting of normal tissue tolerance data to an analytic function.
C. Burman (1991)
10.1016/0360-3016(91)90171-Y
Tolerance of normal tissue to therapeutic irradiation.
B. Emami (1991)
10.1118/1.598063
Reporting and analyzing dose distributions: a concept of equivalent uniform dose.
A. Niemierko (1997)
10.1016/S0167-8140(98)00020-6
Evaluation of two dose-volume histogram reduction models for the prediction of radiation pneumonitis.
S. L. Kwa (1998)
10.2307/2983301
Statistical Models in Epidemiology
D. Clayton (1993)
10.1016/0360-3016(94)90181-3
Dose-volume histogram and 3-D treatment planning evaluation of patients with pneumonitis.
M. Martel (1994)
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)
10.1016/0360-3016(91)90173-2
Histogram reduction method for calculating complication probabilities for three-dimensional treatment planning evaluations.
G. Kutcher (1991)
10.1118/1.597056
Probability of radiation-induced complications for normal tissues with parallel architecture subject to non-uniform irradiation.
A. Jackson (1993)
10.1118/1.596555
On methods of inhomogeneity corrections for photon transport.
J. Wong (1990)
10.7326/0003-4819-86-1-81
Pulmonary effects of radiation therapy.
N. Gross (1977)
10.2307/3583506
Complication probability as assessed from dose-volume histograms.
J. Lyman (1985)
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(97)00343-X
Physical and biological predictors of changes in whole-lung function following thoracic irradiation.
L. Marks (1997)



This paper is referenced by
Stereotactic body radiotherapy in non-small cell lung cancer
Pia Baumann (2009)
10.1016/S0169-5002(03)00228-9
The impact of regional nodal radiotherapy (dose/volume) on regional progression and survival in unresectable non-small cell lung cancer: an analysis of RTOG data.
B. Emami (2003)
10.1053/J.SEMINONCOL.2005.03.009
Non-small cell lung cancer therapy-related pulmonary toxicity: an update on radiation pneumonitis and fibrosis.
F. Kong (2005)
10.1097/00130404-200211000-00009
Effect of Concurrent Radiation Therapy and Chemotherapy on Pulmonary Function in Patients with Esophageal Cancer: Dose‐Volume Histogram Analysis
T. Gergel (2002)
10.1097/00000421-200302000-00014
Reduction in Radiation Dose to Lung and Other Normal Tissues Using Helical Tomotherapy to Treat Lung Cancer, in Comparison to Conventional Field Arrangements
R. Scrimger (2003)
10.1016/J.IJROBP.2006.03.012
Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma.
A. Allen (2006)
10.1016/J.IJROBP.2005.11.012
A technique for adaptive image-guided helical tomotherapy for lung cancer.
C. Ramsey (2006)
10.1118/1.2358205
The impact of hypofractionation on simultaneous dose-boosting to hypoxic tumor subvolumes.
R. Ruggieri (2006)
10.1016/S0761-8425(07)78138-X
Techniques innovantes en radiothérapie des cancers bronchopulmonaires
G. Noël (2007)
10.1016/j.canrad.2010.02.009
[Normal tissue tolerance to external beam radiation therapy: lung].
C. Ortholan (2010)
10.1016/j.ijrobp.2011.03.011
Predictive models for pulmonary function changes after radiotherapy for breast cancer and lymphoma.
B. Sánchez-Nieto (2012)
10.1007/s11604-011-0002-2
Analysis of dose–volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT
G. Kumar (2011)
10.5306/wjco.v5.i4.568
Proton beam therapy for locally advanced lung cancer: A review.
S. Schild (2014)
10.1371/journal.pone.0020055
Polymorphisms of Homologous Recombination Genes and Clinical Outcomes of Non-Small Cell Lung Cancer Patients Treated with Definitive Radiotherapy
M. Yin (2011)
10.1016/J.IJROBP.2006.02.007
Patterns of failure after resection of non-small-cell lung cancer: implications for postoperative radiation therapy volumes.
C. Kelsey (2006)
10.1016/j.radonc.2008.09.009
Dose-volume thresholds and smoking status for the risk of treatment-related pneumonitis in inoperable non-small cell lung cancer treated with definitive radiotherapy.
H. Jin (2009)
10.1016/J.IJROBP.2006.05.041
High-dose simultaneously integrated breast boost using intensity-modulated radiotherapy and inverse optimization.
C. Hurkmans (2006)
10.1186/s13014-017-0891-z
Exclusion of emphysematous lung from dose-volume estimates of risk improves prediction of radiation pneumonitis
Y. Uchida (2017)
10.1016/S0899-5885(18)30094-7
Pulmonary toxicities of cancer therapy.
C. Chernecky (2000)
10.1111/j.1442-2050.2007.00794.x
Preoperative versus postoperative radiotherapy for locally advanced gastroesophageal junction and proximal gastric cancers: a comparison of normal tissue radiation doses.
G. Tillman (2008)
10.1016/j.radonc.2008.10.006
Dyspnea evolution after high-dose radiotherapy in patients with non-small cell lung cancer.
D. D. De Ruysscher (2009)
10.1080/095530000138466
Radiation-induced pulmonary injury: symptomatic versus subclinical endpoints
L. B. Marks, M. Fan, R. Clough, M. Munley, G. Bentel, (2000)
10.1118/1.1558675
Quantifying the predictability of diaphragm motion during respiration with a noninvasive external marker.
S. Vedam (2003)
Incidència de metàstasis en la cadena mamaria interna amb la tècnica del gangli sentinella en càncer de mama i les seves implicacions en radioteràpia.
Farrús Lucaya (2006)
10.1016/j.semradonc.2009.09.001
Radiation-related treatment effects across the age spectrum: differences and similarities or what the old and young can learn from each other.
M. Krasin (2010)
10.1016/j.cllc.2015.08.007
Renin-Angiotensin System Inhibitors Might Help to Reduce the Development of Symptomatic Radiation Pneumonitis After Stereotactic Body Radiotherapy for Lung Cancer.
S. Bracci (2016)
The Management of Respiratory Motion in Radiation Oncology Handout for AAPM 2005 Continuing Education Session, based on the
P. Keall (2005)
10.1007/BF02493278
Change in dose distribution of three-dimensional conformal radiotherapy during treatment for lung tumor
K. Yamada (2006)
10.1016/J.RADONC.2004.03.012
Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold.
A. Pedersen (2004)
10.1186/1748-717X-6-78
Breathing adapted radiotherapy: a 4D gating software for lung cancer
N. Péguret (2011)
10.1002/cncr.21007
Results of a phase I dose‐escalation study using three‐dimensional conformal radiotherapy in the treatment of inoperable nonsmall cell lung carcinoma
K. Rosenzweig (2005)
10.3389/fonc.2020.01153
Adoption of Biologically Effective Dose of the Non-Target Lung Volume to Predict Symptomatic Radiation Pneumonitis After Stereotactic Body Radiation Therapy With Variable Fractionations for Lung Cancer
Y. Jiao (2020)
See more
Semantic Scholar Logo Some data provided by SemanticScholar