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. 2011 Jan;50(1):51-60.
doi: 10.3109/0284186X.2010.521192. Epub 2010 Sep 28.

Heart irradiation as a risk factor for radiation pneumonitis

Ellen X Huang  1 , Andrew J Hope, Patricia E Lindsay, Marco Trovo, Issam El Naqa, Joseph O Deasy, Jeffrey D Bradley
Affiliations

Heart irradiation as a risk factor for radiation pneumonitis

Ellen X Huang et al. Acta Oncol. 2011 Jan.

Abstract

Purpose: to investigate the potential role of incidental heart irradiation on the risk of radiation pneumonitis (RP) for patients receiving definitive radiation therapy for non-small-cell lung cancer (NSCLC).

Material and methods: two hundred and nine patient datasets were available for this study. Heart and lung dose-volume parameters were extracted for modeling, based on Monte Carlo-based heterogeneity corrected dose distributions. Clinical variables tested included age, gender, chemotherapy, pre-treatment weight-loss, performance status, and smoking history. The risk of RP was modeled using logistic regression.

Results: the most significant univariate variables were heart related, such as heart heart V65 (percent volume receiving at least 65 Gy) (Spearman Rs = 0.245, p < 0.001). The best-performing logistic regression model included heart D10 (minimum dose to the hottest 10% of the heart), lung D35, and maximum lung dose (Spearman Rs = 0.268, p < 0.0001). When classified by predicted risk, the RP incidence ratio between the most and least risky 1/3 of treatments was 4.8. The improvement in risk modeling using lung and heart variables was better than using lung variables alone.

Conclusions: these results suggest a previously unsuspected role of heart irradiation in many cases of RP.

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Figures

Figure 1
Figure 1
Coronal view of a treatment plan with a significant high dose overlap with the heart (yellow contour line: whole lung; green contour line: PTV; blue contour line: heart).
Figure 2
Figure 2
(a) Univariate Spearman's rank correlation of RP events with Dx's of the normal lungs or heart volumes; (b) Univariate Spearman's rank correlation of RP events with Vx's of the normal lung or heart volumes; (c) Univariate Spearman's rank correlation of RP events with ‘MOHx’ of normal lung or the heart. Dx is the minimum dose to the x% volume receiving the highest dose (the peak in the heart curve near a Dx of 5%); Vx is the percent volume receiving at least x dose (in Gy)( the peak in heart Vx near 65-70 Gy); MOHx is mean dose of the hottest x% of a structure.
Figure 3
Figure 3
The cross-correlations of intra-organ or inter-organs dosimetric parameters: (a) Dx_Lung vs. Vx_Lung; (b) Dx_Heart vs. Vx_ Heart; (c) MOHx_H vs. MOHx_L. Note: NTCP: normal tissue complication probability.
Figure 4
Figure 4
Multivariate model selection bootstrap frequency (MaxD_L: Maximum Lung Dose; ConChemo: Con-current chemotherapy). The variable selection process was done using bootstrap sampling technique. The frequency of model selection is shown for the five most frequently selected models.
Figure 5
Figure 5
Mean predicted rates of RP vs. observed rates for patients binned by predicted risk. The patients are binned according to predicted risk of RP by the three-variable model (heart D10, lung D35, and maximum dose of the lung) with equal patient numbers in each bin. The mean predicted and observed event rates in each bin are (risk; events/pts.): (0.0581; 5/35), (0.1087; 1/35), (0.1671; 6/35), (0.2481; 7/35), (0.3494; 11/35), (0.4568; 18/35).
Figure 6
Figure 6
ROC curve based on the best three-variable logistic regression model: heart D10, lung D35, and maximum dose of the lung, with area under the curve (AUC) of 0.72.
Figure 7
Figure 7
Scattering plots: a. D35_L vs. and MaxD_L; b. D10_H vs. D35_L; c. D10_H vs. MLD.
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References

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