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. 2016 Dec;89(1068):20160560.
doi: 10.1259/bjr.20160560. Epub 2016 Nov 2.

Dosimetric factors predicting radiation pneumonitis after CyberKnife stereotactic body radiotherapy for peripheral lung cancer

Masaki Nakamura  1 , Hideki Nishimura  1 , Masao Nakayama  1 , Hiroshi Mayahara  1 , Haruka Uezono  1 , Aya Harada  1 , Naoki Hashimoto  1 , Yasuo Ejima  2 , Takeaki Ishihara  2 , Ryohei Sasaki  2
Affiliations

Dosimetric factors predicting radiation pneumonitis after CyberKnife stereotactic body radiotherapy for peripheral lung cancer

Masaki Nakamura et al. Br J Radiol. 2016 Dec.

Abstract

Objective: The aims of this study were to investigate the frequency of symptomatic radiation pneumonitis (RP) after CyberKnife lung stereotactic body radiotherapy (SBRT) and to evaluate predictive factors of symptomatic RP.

Methods: 56 patients with peripheral non-small-cell lung cancer were treated using the CyberKnife® VSI™ System (Accuracy Inc., Sunnyvale, CA) between May 2013 and September 2015. Total radiation doses ranged from 48 to 56 Gy, as delivered in four equal fractions. Symptomatic RP was defined as a grade of ≥2. Predictive factors for symptomatic RP were evaluated using univariate and multivariate analyses.

Results: With a median follow-up duration of 12.5 months (range, 3-27 months), symptomatic RP was observed in 6 (10.7%) of the 56 patients. In the univariate analysis, percent vital capacity (p < 0.05), maximum tumour diameter (p < 0.05), gross tumour volume (p < 0.05), planning target volume (p < 0.01), mean lung dose (p < 0.01) and a normal lung volume receiving 5-50 Gy of radiation (V5-50) (p < 0.01) were identified as significant predictive factors for symptomatic RP. In the multivariate analysis, only a V25 >3.4% (p = 0.011) was identified as a significant predictive factor of symptomatic RP.

Conclusion: The incidence of symptomatic RP after CyberKnife SBRT was almost identical to the incidences reported in the linear accelerator-based SBRT. A significant association was observed between a V25 >3.4% and the risk of developing symptomatic RP. Advances in knowledge: This is the first report that has investigated prognostic factors for symptomatic RP after CyberKnife SBRT for lung cancer. The newly developed scoring system may help to predict symptomatic RP.

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Figures

Figure 1.
Figure 1.
(a) Cumulative incidence curves of symptomatic radiation pneumonitis stratified by the normal lung volume receiving 25 Gy of radiation (V25). (b) Cumulative incidence curves of symptomatic radiation pneumonitis stratified by the predictive score of symptomatic radiation pneumonitis after stereotactic body radiotherapy (PSRS).
See this image and copyright information in PMC

References

    1. Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, et al. . Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol 2007; 2(7 Suppl. 3): S94−100. doi: https://doi.org/10.1097/JTO.0b013e318074de34 - DOI - PubMed
    1. Grills IS, Mangona VS, Welsh R, Chmielewski G, McInerney E, Martin S, et al. . Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small-cell lung cancer. J Clin Oncol 2010; 28: 928−35. doi: https://doi.org/10.1200/JCO.2009.25.0928 - DOI - PubMed
    1. Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, et al. . Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 2015; 16: 630−37. doi: https://doi.org/10.1016/S1470-2045(15)70168-3 - DOI - PMC - PubMed
    1. Seppenwoolde Y, Shirato H, Kitamura K, Shimizu S, van Herk M, Lebesque JV, et al. . Precise and real-time measurement of 3D tumor motion in lung due to breathing and heartbeat, measured during radiotherapy. Int J Radiat Oncol Biol Phys 2002; 53: 822−34. doi: https://doi.org/10.1016/S0360-3016(02)02803-1 - DOI - PubMed
    1. Casamassima F, Cavedon C, Francescon P, Stancanello J, Avanzo M, Cora S, et al. . Use of motion tracking in stereotactic body radiotherapy: evaluation of uncertainty in off-target dose distribution and optimization strategies. Acta Oncol 2006; 45: 943−7. doi: https://doi.org/10.1080/02841860600908962 - DOI - PubMed