Radiation pneumonitis after breast cancer irradiation:: Analysis of the complication probability using the relative seriality model
Radiation pneumonitis after breast cancer irradiation:: Analysis of the complication probability using the relative seriality model
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DOI：
10.1016/s0360-3016(99)00420-4
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发表时间：
2000-01-15
影响因子：
7
通讯作者：
Rutqvist, LE
中科院分区：
文献类型：
--
作者：
Gagliardi, G;Bjöhle, J;Rutqvist, LE
背景：胸部肿瘤放疗后的呼吸系统毒性相当普遍；乳腺癌患者是预期存活时间较长的人群之一。肺组织对辐照反应的量化对于设计并发症最少和肿瘤控制最多的治疗方法非常重要。方法：研究人群包括68例接受二期乳腺癌放疗的患者。根据临床症状和影像学表现对放射性肺炎进行回顾性评估。对于每个患者，可以测量暴露（即肺剂量-体积直方图[DVH]）和测量结果。基于这些数据，对相对序列模型进行了最大似然拟合。计算了模型参数的不确定性，并研究了它们对剂量-响应曲线的影响。将最佳参数集应用于其他5组乳腺癌患者，计算正常组织并发症概率（NTCP）。各组采用不同的放疗技术进行个体化治疗；用平均DVH描述剂量在肺中的分布，并了解各组放射性肺炎的发病率。通过所有的计算，假定肺放射敏感性是均匀的。结果：相对序列模型可以描述数据集，发现体积效应与放射性肺炎的描述相关。年龄与放射性肺炎的风险增加有关。按年龄分组得到两条不同的剂量-反应曲线，参数不确定性对剂量-反应曲线的影响较大，所确定的参数集可用于5组患者中的3组进行预测。结论：并发症数据可以用相对序列模型进行建模，但在临床应用NTCP模型之前，必须对更多的独立数据集进行分析，并根据同一终点进行分类。(C) 2000 Elsevier Science Inc.；
Background: Toxicity of the respiratory system is quite common after radiotherapy of thoracic tumors; breast cancer patients represent one of the groups for which there is also a long expected survival. The quantification of lung tissue response to irradiation is important in designing treatments associated with a minimum of complications and maximum tumor control.Methods: The study population consisted of 68 patients who received irradiation for breast cancer at Stage II. radiation pneumonitis was retrospectively assessed on the basis of clinical symptoms and radiological findings. For each patient, a measure of the exposure (i.e., the lung dose-volume histogram [DVH]) and a measure of the outcome was available. Based on these data, a maximum likelihood fitting to the relative seriality model was performed. The uncertainties of the model parameters were calculated and their impact on the dose-response curve was studied. The optimum parameter set was then applied to 5 other patient groups treated for breast cancer, and the normal tissue complication probability (NTCP) was calculated. Each group was individuated by the radiotherapy treatment technique used; the dose distribution in the lung was described by a mean DVH and the incidence of radiation pneumonitis in each group was known. Lung radiosensitivity was assumed to be homogeneous through all of the calculations.Results: The relative seriality model could describe the dataset, The volume effect was found to be relevant in the description of radiation pneumonitis. Age was found to be associated with increased risk of radiation pneumonitis. Two distinct dose-response curves were obtained by splitting the group according to age, The impact of the parameter uncertainties on the dose-response curve was quite large, The parameter set determined could be used predictively on 3 of the 5 patient groups.Conclusion: The complication data could be modeled with the relative seriality model, However, further independent datasets, classified according to the same endpoint, must be analyzed before introducing NTCP modeling in clinical practice. (C) 2000 Elsevier Science Inc.