CHEST WALL VOLUME RECEIVING >30 GY PREDICTS RISK OF SEVERE PAIN AND/OR RIB FRACTURE AFTER LUNG STEREOTACTIC BODY RADIOTHERAPY
CHEST WALL VOLUME RECEIVING >30 GY PREDICTS RISK OF SEVERE PAIN AND/OR RIB FRACTURE AFTER LUNG STEREOTACTIC BODY RADIOTHERAPY
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DOI：
10.1016/j.ijrobp.2009.02.027
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发表时间：
2010-03-01
影响因子：
7
通讯作者：
Larner, James M.
中科院分区：
文献类型：
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作者：
Dunlap, Neal E.;Cai, Jing;Larner, James M.
目的：确定预测肺部立体定向全身放射治疗后胸壁疼痛和/或肋骨骨折风险的剂量-体积参数。方法与材料：从多机构的综合经验出发，对60例连续接受3~5次立体定向全身放射治疗的原发或转移性周围肺病变患者进行回顾。使用疼痛的共同毒性标准评估CW疼痛。周围肺病变定义为位于CW 2.5 cm以内的病变。CW的最小点剂量为20Gy.结果：60例患者中，17例出现3级慢性疼痛，5例肋骨骨折。出现严重疼痛和/或骨折的中位间隔时间为7.1个月。CW毒性风险符合半数有效浓度剂量-反应模型。接受30GyCW体积最能预测重度CW疼痛和/或肋骨骨折的风险(R2=0.9552)。在报告剧烈疼痛和/或肋骨骨折之前，观察到30 cm(3)的体积阈值。CW剂量为35cm3时发生CW严重毒性的风险为30%。结论：CW毒性的发生与临床有关，CW应被视为治疗计划中的危险器官。分三到五次接受30GyCW的体积应限制在
Purpose: To identify the dose-volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy.Methods and Materials: From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving >= 20, >= 30, >= 40, >= 50, and >= 60 Gy was determined and related to the risk of CW toxicity.Results: Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose-response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R-2 = 0.9552). A volume threshold of 30 cm(3) was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm 3 receiving 30 Gy.Conclusion: The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to