International Journal of Radiation Oncology*Biology*Physics
3D-CRTProspective evaluation of early lung toxicity following three-dimensional conformal radiation therapy in non–small-cell lung cancer: preliminary results1☆,
Introduction
The prognosis of non–small-cell lung cancer (NSCLC) remains poor because of inadequate control at the primary site after radiation therapy. Local control achievement is a requirement for survival benefits 1, 2. High dose of thoracic irradiation is associated with an improvement of local control when using either classical fractionation 3, 4, 5 or using hyperfractionated accelerated radiotherapy 6, 7, 8, 9, 10.
The tolerance of the normal lung tissue limits the dose that can be delivered, and radiation pneumonitis is the restricting complication following lung cancer irradiation. Radiation pneumonitis after thoracic irradiation has been reported in several series, even with conformal radiotherapy 11, 12, 13, 14, 15.
The relationship between the dose–volume histogram (DVHs) and the occurrence of pneumonitis improves knowledge of radiotherapy toxicity 16, 17, 18, 19. Three-dimensional conformal radiotherapy (3D-CRT) permits an improvement in tailoring target volume and minimizing normal lung irradiation. This should allow the delivery of higher doses without increasing the complication rates 20, 21.
The aim of this study was a prospective evaluation of pulmonary toxicity following 3D-CRT. The predictive value of DVHs in pneumonitis occurrence was investigated. An analysis of functional changes after pulmonary irradiation has been performed. The relation between DVHs and the reduction of lung function parameters has been analyzed.
Section snippets
Methods and materials
Between November 1996 and February 1999, 54 patients with histologically proven nonmetastatic NSCLC were included in a prospective study to evaluate the pulmonary toxicity after 3D-CRT.
Results
The volume of PTV1 and PTV2 for the 54 patients, for the 9 pneumonectomy patients, and for the 45 patients without pneumonectomy are presented in Table 1. The volumes of PTV1 and PTV2 were smaller for pneumonectomy patients, when compared with other patients.
Twenty cases of radiation pneumonitis more than or equal to Grade 2 according to the Lent–Soma scale were observed (Table 2). Eleven patients had Grade 2 pneumonitis and 9 patients had Grade 3 pneumonitis. Sixteen patients among these 20
Discussion
The influence of heterogeneity on dose calculation has been studied 1, 15. Graham et al. (1) compared dose delivered to PTV1 and to PTV2 with and without heterogeneity dose calculation. In PTV2, an underdosage of 5% or less was observed in 55% of patients and an overdosage of 10% in 29% of patients when heterogeneities were not taken into account. Martel et al. (15) decided to use heterogeneity corrected calculations, after analyzing the influence of heterogeneity corrected calculations. In our
References (26)
- et al.
Preliminary results of a prospective trial using three dimensional radiotherapy for lung cancer
Int J Radiat Oncol Biol Phys
(1995) - et al.
Radiotherapy alone for medically inoperable stage I non small-cell lung cancerThe duke experience
Int J Radiat Oncol Biol Phys
(1998) - et al.
Result of high dose thoracic irradiation incorporating beam’s eye view display in non small cell lung cancerA retrospective multivariate analysis
Int J Radiat Oncol Biol Phys
(1993) The evolution of radiation therapy oncology group (RTOG) protocols for non–small-cell lung cancer
Int J Radiat Oncol Biol Phys
(1995)- et al.
Risk factors for development of radiation pneumonitis following radiation therapy with or without chemotherapy for lung cancer
Int J Radiat Oncol Biol Phys
(1997) - et al.
Plasma transforming growth factor B1 as a predictor of radiation pneumonitis
Int J Radiat Oncol Biol Phys
(1998) - et al.
Estimation of pneumonitis risk in three dimensional treatment planning using dose–volume histogram analysis
Int J Radiat Oncol Biol Phys
(1995) - et al.
Tolerance of normal tissue to therapeutic irradiation
Int J Radiat Oncol Biol Phys
(1991) - et al.
Fitting of normal tissue tolerance data to an analytic function
Int J Radiat Oncol Biol Phys
(1991) - et al.
Dose escalation for non small cell lung cancer using conformal radiation therapy
Int J Radiat Oncol Biol Phys
(1997)
Comparison of two repositioning devices used during radiation therapy for Hodgkin’s disease
Int J Radiat Oncol Biol Phys
Quantification of radiation-induced regional lung injury with perfusion imaging
Int J Radiat Oncol Biol Phys
Promising survival with three-dimensional conformal radiation therapy for non-small cell lung cancer
Radiother Oncol
Cited by (45)
Comparing the Outcomes of Stereotactic Ablative Radiotherapy and Non-Stereotactic Ablative Radiotherapy Definitive Radiotherapy Approaches to Thoracic Malignancy: A Systematic Review and Meta-Analysis
2018, Clinical Lung CancerCitation Excerpt :To identify articles in which mediastinal structures were adjacent to the high-dose region, articles were selected in which patients with nodal disease were included (stage IIIA and stage IIIB), or in which it was specified that the mediastinal nodes were included within the radiotherapy field. Mediastinal toxicities, including esophagitis, bronchial, and cardiac toxicities were recorded in 23 of 87 SABR articles and 15 of 24 non-SABR articles (Tables 312-43 and 444-64). In SABR articles the most common form of toxicity was esophagitis with 5 articles reporting Grade ≥2 esophagitis (16 patients, <1% of all SABR patients), 4 articles reporting pulmonary hemorrhage (12 patients, with most Grade 5), 4 articles reporting cardiac toxicity (11 patients who developed pericardial effusions, atrial fibrillation, and acute myocardial infarction), and 3 articles reporting bronchial strictures or tracheo-esophageal necrosis in 4 patients.
Comparison of risk and predictors for early radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with radiotherapy with or without surgery
2014, Lung CancerCitation Excerpt :Results from studies of the correlation between PTV and the risk of RP have been inconsistent. Sunyach et al. [17] showed that a PTV >200 cm3 was a risk factor for RP, whereas Huang et al. [18] found no correlation between tumor size and RP. We reasoned that this discrepancy might be related to differences in total lung volume of different patients; that is, a lower percentage of lung would be irradiated in patients with a larger lung volume and a higher percent of lung would be irradiated in patients with a smaller lung volume when their PTV were equal.
Being lax with taxanes can be taxing!
2013, International Journal of Radiation Oncology Biology PhysicsThe Challenge of Scoring Radiation-induced Lung Toxicity
2009, Clinical OncologyCitation Excerpt :Planning dose constraints are derived from publications where the reported end point is radiation-induced late lung toxicity [2,4,6–10,15,16]. Recent studies evaluating the value of different biological and physical predictors for radiation-induced lung toxicity used scoring scales based on symptoms only, suggesting some inadequacy with the RTOG/EORTC scale [6–10]. In one of our Canadian Association Radiation Oncology meetings, the case illustrated in Fig. 1 was shown and the audience was asked to score the late lung toxicity according to the RTOG/EORTC schema.
Dosimetric analysis of the patterns of local failure observed in patients with locally advanced non-small cell lung cancer treated with neoadjuvant chemotherapy and concurrent conformal (3D-CRT) chemoradiation
2008, Radiotherapy and OncologyCitation Excerpt :The local recurrence rates range between 20% and 85% (the lowest rate was reported in a study that included patients with stages I and II disease) [26–33]. Studies reporting on the combination of chemotherapy and 3D-CRT in patients with locally advanced NSCLC shown a rate of local recurrence of the disease ranging between 3% and 73% [25,34–52]. The most favorable local recurrence data (3%) were reported in a study of 29 patients published as a abstract by University of North Carolina [40].
Lung perfusion imaging can risk stratify lung cancer patients for the development of pulmonary complications after chemoradiation
2008, Journal of Thoracic Oncology
- ☆
Grants: PHRC no. 2701; Ligue contre le Cancer de l’Ain, Aide Recherche 1996–1997; Ligue contre le Cancer du Rhône, Aide Recherche 1996–1997.
- 1
Acknowledgments—The authors acknowledge Mr. Toms for valuable help with English, and Michel Drevon for statistical analysis help.