Dose-volume modeling of the risk of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery
Dose-volume modeling of the risk of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery
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DOI：
10.1016/j.ijrobp.2006.06.002
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发表时间：
2006-11-01
影响因子：
7
通讯作者：
Mohan, Radhe
中科院分区：
文献类型：
--
作者：
Tucker, Susan L.;Liu, H. Helen;Mohan, Radhe
目的：本研究的目的是探讨放射剂量分布在肺部的影响，术后肺部并发症的风险食管癌patients.Methods和材料：我们分析了110例食管癌患者的数据，同时放化疗，然后在我们的机构从1998年至2003年的手术。分析终点为术后肺炎或急性呼吸窘迫综合征。使用全肺的剂量体积直方图（DVH）和剂量质量直方图（DMHs）拟合正常组织并发症概率（NTCP）模型，并使用bootstrap分析比较拟合质量。正常组织并发症概率模型确定，术后肺部并发症的风险与剂量>= 5戈伊（VS 5）的小绝对肺体积最显著相关，即暴露于<5戈伊的剂量。然而，自举分析发现，该模型的质量与基于其他剂量学参数（包括平均肺剂量、有效剂量和接受>= 5戈伊的肺相对体积）的拟合之间没有显著差异，这可能是因为这些因素之间存在相关性。DVH与DMH的选择或分馏校正的使用对NTCP建模的结果没有显著影响。莱曼NTCP模型的参数估计值如下（括号内为95%置信区间）：n = 1.85（0.04，无穷大），m = 0.55（0.22，1.02），D-50 = 17.5戈伊（9.4戈伊，102戈伊）。结论：在这个食管癌患者队列中，几个剂量学参数，包括平均肺剂量，有效剂量，和接受<5戈伊的肺绝对体积提供了作为肺内辐射剂量分布函数的术后肺部并发症风险的相似描述。(c)2006年爱思唯尔公司
Purpose: The aim of this study was to investigate the effect of radiation dose distribution in the lung on the risk of postoperative pulmonary complications among esophageal cancer patients.Methods and Materials: We analyzed data from 110 patients with esophageal cancer treated with concurrent chemoradiotherapy followed by surgery at our institution from 1998 to 2003. The endpoint for analysis was postsurgical pneumonia or acute respiratory distress syndrome. Dose-volume histograms (DVHs) and dose-mass histograms (DMHs) for the whole lung were used to fit normal-tissue complication probability (NTCP) models, and the quality of fits were compared using bootstrap analysis.Results: Normal-tissue complication probability modeling identified that the risk of postoperative pulmonary complications was most significantly associated with small absolute volumes of lung spared from doses >= 5 Gy (VS5), that is, exposed to doses < 5 Gy. However, bootstrap analysis found no significant difference between the quality of this model and fits based on other dosimetric parameters, including mean lung dose, effective dose, and relative volume of lung receiving >= 5 Gy, probably because of correlations among these factors. The choice of DVH vs. DMH or the use of fractionation correction did not significantly affect the results of the NTCP modeling. The parameter values estimated for the Lyman NTCP model were as follows (with 95% confidence intervals in parentheses): n = 1.85 (0.04, infinity), m = 0.55 (0.22, 1.02), and D-50 = 17.5 Gy (9.4 Gy, 102 Gy).Conclusions: In this cohort of esophageal cancer patients, several dosimetric parameters including mean lung dose, effective dose, and absolute volume of lung receiving < 5 Gy provided similar descriptions of the risk of postoperative pulmonary complications as a function of the radiation dose distribution in the lung. (c) 2006 Elsevier Inc.