Incidence, risk factors, and dose-volume relationship of radiation-induced rib fracture after carbon ion radiotherapy for lung cancer
Incidence, risk factors, and dose-volume relationship of radiation-induced rib fracture after carbon ion radiotherapy for lung cancer
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DOI：
10.3109/0284186x.2015.1088169
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发表时间：
2016-02-01
期刊：
影响因子：
3.1
通讯作者：
Nakano, Takashi
中科院分区：
文献类型：
--
作者：
Abe, Takanori;Shirai, Katsuyuki;Nakano, Takashi
背景资料：本研究的目的是评估肺癌碳离子放疗后放射性肋骨骨折（RIRF）的发生率、危险因素和剂量-体积关系。材料和方法：对18例接受碳离子放疗的周围I期非小细胞肺癌患者的57根肋骨进行肋骨骨折分析。患者接受总剂量52.8戈伊[相对生物学有效性（RBE）]或60.0戈伊（RBE）分4次治疗，并随访至少6个月。患者的特点和剂量学参数进行了分析与RIRF.Results：18例患者和57肋骨在这项研究中。中位随访时间为36.5个月。在18名患者中的7名（39%）和57根肋骨中的11名（19%）中观察到RIRF。只有1例患者出现症状性骨折。骨折肋骨与肿瘤部位的距离明显短于非骨折肋骨（1.4 ± 0.3cm vs. 2.5 ± 0.3cm）。受试者工作特征曲线分析表明，以D-1cm（3）作为判别RIRF的临界值，其曲线下面积最大（AUC=0.78）。根据截止值确定的两组中RIRF的两年累积发生率的比较得出以下结果：53% vs. 4% [D-1cm（3）>= 38.2戈伊（RBE）或更低]。两组结果有显著性差异（p
Background: The purpose of this study was to assess the incidence, risk factors, and dose-volume relationship of radiation-induced rib fracture (RIRF) after carbon ion radiotherapy for lung cancer.Material and methods: Fifty-seven ribs of 18 patients with peripheral stage I non-small cell lung cancer treated with carbon ion radiotherapy were analyzed on rib fracture. The patients were treated at a total dose of 52.8 Gy [relative biologic effectiveness (RBE)] or 60.0 Gy (RBE) in 4 fractions and were followed at least six months. Patient characteristics and dosimetric parameters were analyzed for associations with RIRF.Results: Eighteen patients and 57 ribs were included in this study. The median length of follow-up was 36.5 months. RIRF was observed in seven (39%) of the 18 patients, and in 11 (19%) of 57 ribs. Only one patient developed symptomatic fracture. The distance from the ribs to the tumor site was significantly shorter in fractured ribs than in non-fractured ribs (1.40.3cm vs. 2.5 +/- 0.3cm). Receiver operating characteristic curve analysis showed that D-1cm (3) as a cut-off value for discriminating RIRF had the largest area under the curve (AUC=0.78). Comparison of the two-year cumulative incidence of RIRF among two groups as determined by cut-off values, yielded the following result: 53% vs. 4% [D-1cm (3) >= 38.2 Gy (RBE) or less]. Results from the two groups were significantly different (p