Pulmonary dose-volume predictors of radiation pneumonitis following stereotactic body radiation therapy
Pulmonary dose-volume predictors of radiation pneumonitis following stereotactic body radiation therapy
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DOI：
10.1016/j.prro.2016.01.015
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发表时间：
2016-11-01
影响因子：
3.3
通讯作者：
Decker, Roy H.
中科院分区：
文献类型：
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作者：
Harder, Eileen M.;Park, Henry S.;Decker, Roy H.
目的：放射性肺炎（RP）在立体定向全身放射治疗后可能是严重的。我们的目的是确定预测立体定向全身放射治疗后>= 2 RP的肺和心脏剂量学参数。方法与材料：共纳入335例患者，随访3个月。正常肺体积为肺总体积减去肿瘤总体积。收集肺最大剂量、平均肺剂量（MLD）和5 ~ 50gy增量下>= x Gy的肺百分比。记录心脏最大剂量、平均剂量、>= 0.1 Gy （V0.1）、V0.25 ~ V1、V2.5 ~ V12.5时肺体积。采用多变量logistic回归和人工逆向逐步消除法来确定毒性的最佳剂量学预测因子。采用递归分配分析（RPA）分离出最佳剂量-体积截止点。结果：>= 2级RP率为18.8%。单因素分析显示，肺V5 ~ V50、MLD和心脏V0.1 ~ V2.5与毒性显著相关。在多变量logistic回归中，V10是>= 2 RP的最强剂量学预测因子（优势比为1.052；95%可信区间为1.014-1.092；P= 0.007）。RPA鉴定出>= 2级RP的风险为21.6%,V10 >= 6.14% (vs = 3级RP的风险为3.8%)（优势比为1.002；95%可信区间为1.000-1.003；P= 0.031）。当MLD >= 7.84 Gy时，RPA鉴定>= 3级RP的风险为25.0%（而当= 2 RP率为18.8%时为8.0%），肺V10是>= 2级毒性的最佳预测因子。MLD是>= 3级RP的最佳预测因子。(C) 2016年美国放射肿瘤学会。Elsevier Inc.出版。版权所有。
Purpose: Radiation pneumonitis (RP) may be severe after stereotactic body radiation therapy. Our purpose was to identify pulmonary and cardiac dosimetric parameters that predicted for post-stereotactic body radiation therapy grade >= 2 RP.Methods and materials: A total of 335 patients with >= 3 months' follow-up were included. Normal pulmonary volume was total lungs minus gross tumor volume. Pulmonary maximum dose, mean lung dose (MLD), and the percent of lung receiving >= x Gy for 5 to 50 Gy in 5-Gy increments were collected. Cardiac maximum dose, mean dose, volume of lung receiving >= 0.1 Gy (V0.1), V0.25 to V1, and V2.5 to V12.5 were recorded. Multivariable logistic regression with manual backward stepwise elimination was used to identify the best dosimetric predictors of toxicity. Optimal dose-volume cutoffs were isolated with recursive partitioning analysis (RPA).Results: The grade >= 2 RP rate was 18.8%. Pulmonary V5 to V50, MLD, and cardiac V0.1 to V2.5 were significantly associated with toxicity on univariate analysis. On multivariable logistic regression, V10 was the strongest dosimetric predictor of grade >= 2 RP (odds ratio, 1.052; 95% confidence interval, 1.014-1.092; P=.007). RPA identified a 21.6% risk of grade >= 2 RP with V10 >= 6.14% (vs 3.8% with = 3 RP (odds ratio, 1.002; 95% confidence interval, 1.000-1.003; P=.031). RPA identified a 25.0% risk of grade >= 3 RP with MLD >= 7.84 Gy (vs 8.0% when = 2 RP rate of 18.8%, lung V10 was the best predictor of grade >= 2 toxicity. MLD was the best predictor of grade >= 3 RP. (C) 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.