Clinical and Dosimetric Predictors of Radiation Pneumonitis in a Large Series of Patients Treated With Stereotactic Body Radiation Therapy to the Lung
Clinical and Dosimetric Predictors of Radiation Pneumonitis in a Large Series of Patients Treated With Stereotactic Body Radiation Therapy to the Lung
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DOI：
10.1016/j.ijrobp.2012.03.041
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发表时间：
2013-01-01
影响因子：
7
通讯作者：
Dilling, Thomas J.
中科院分区：
文献类型：
--
作者：
Baker, Ryan;Han, Gang;Dilling, Thomas J.
目的：报告240例接受肺立体定向放射治疗（SBRT）患者的临床和剂量学因素预测放射性肺炎（RP）。方法和材料：在治疗263例患者的297个等中心中，240例患者（n=263个等中心）具有可评估的RP信息。记录年龄、性别、吸烟现状及包龄、O-2使用情况、Charlson共病指数、既往肺放射治疗（是/否）、剂量/分次、V-5、V-13、V-20、v -处方、平均肺剂量、计划靶体积（PTV）、总肺体积、PTV/肺体积比。结果：29例（11.0%）出现症状性肺炎（2级26例，3级3例）。平均V-20为6.5%（范围0.4% ~ 20.2%），平均肺剂量为5.03 Gy （0.547 ~ 12.2 Gy）。单变量分析中，女性（P= 0.0257）和Charlson合并症指数（P= 0.066）对RP有显著预测作用。在剂量学参数中，V-5 （P= 0.0186）、V-13 （P= 0.0438）和v -处方（剂量=60 Gy） （P= 0.0128）具有显著性。只有V-20有显著性趋势（P= 0.0610）。规划目标肺容积与正常肺容积之比极显著（P= 0.0024）。在多变量分析中，女性性别、吸烟包年、较大的内部肿瘤体积和PTV等临床因素具有预测意义（P= 0.0094， P= 0.001）。0312年,。0364，和。052)，但剂量学因素均不显著。结论：症状性RP发生率为11%。我们的平均肺剂量为
Purpose: To report clinical and dosimetric factors predictive of radiation pneumonitis (RP) in patients receiving lung stereotactic body radiation therapy (SBRT) from a series of 240 patients.Methods and Materials: Of the 297 isocenters treating 263 patients, 240 patients (n=263 isocenters) had evaluable information regarding RP. Age, gender, current smoking status and pack-years, O-2 use, Charlson Comorbidity Index, prior lung radiation therapy (yes/no), dose/fractionation, V-5, V-13, V-20, V-prescription, mean lung dose, planning target volume (PTV), total lung volume, and PTV/lung volume ratio were recorded.Results: Twenty-nine patients (11.0%) developed symptomatic pneumonitis (26 grade 2, 3 grade 3). The mean V-20 was 6.5% (range, 0.4%-20.2%), and the average mean lung dose was 5.03 Gy (0.547-12.2 Gy). In univariable analysis female gender (P=.0257) and Charlson Comorbidity index (P=.0366) were significantly predictive of RP. Among dosimetric parameters, V-5 (P=.0186), V-13 (P=.0438), and V-prescription (where dose=60 Gy) (P=.0128) were significant. There was only a trend toward significance for V-20 (P=.0610). Planning target volume/normal lung volume ratio was highly significant (P=.0024). In multivariable analysis the clinical factors of female gender, pack-years smoking, and larger gross internal tumor volume and PTV were predictive (P=.0094, .0312, .0364, and .052, respectively), but no dosimetric factors were significant.Conclusions: Rate of symptomatic RP was 11%. Our mean lung dose was