Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy

Gerben R Borst; Masayori Ishikawa; Jasper Nijkamp; Michael Hauptmann; Hiroki Shirato; Rikiya Onimaru; Michel M van den Heuvel; Jose Belderbos; Joos V Lebesque; Jan-Jakob Sonke

doi:10.1016/j.radonc.2009.02.003

Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy

Gerben R Borst
, Masayori Ishikawa
, Jasper Nijkamp
, Michael Hauptmann
, Hiroki Shirato
, Rikiya Onimaru
, Michel M van den Heuvel
, Jose Belderbos
, Joos V Lebesque
, Jan-Jakob Sonke

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

PURPOSE: We evaluated the relationship between the mean lung dose (MLD) and the incidence of radiation pneumonitis (RP) after stereotactic body radiation therapy (SBRT), and compared this with conventional fractionated radiation therapy (CFRT).

MATERIALS AND METHODS: For both SBRT (n=128) and CFRT (n=142) patients, RP grade > or = 2 was scored. Toxicity models predicting the probability of RP as a function of the MLD were fitted using maximum log likelihood analysis. The MLD was NTD (Normalized Total Dose) corrected using an alpha/beta ratio of 3 Gy.

RESULTS: SBRT patients were treated with 6-12 Gy per fraction with a median MLD of 6.4 Gy (range: 1.5-26.5 Gy). CFRT patients were treated with 2 Gy or 2.25 Gy per fraction, the median MLD was 13.2 Gy (range: 3.0-23.0 Gy). The crude incidence rates of RP were 10.9% and 17.6% for the SBRT and CFRT patients, respectively. A significant dose-response relationship for RP was found after SBRT, which was not significantly different from the dose-response relationship for CFRT (p=0.18).

CONCLUSION: We derived a significant dose-response relationship between the risk of RP and the MLD for SBRT from the clinical data. This relation was not significantly different from the dose-response relation for CFRT, although statistical analysis was hampered by the low number of patients in the high dose range.

Original language	English
Pages (from-to)	307-13
Number of pages	7
Journal	Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Volume	91
Issue number	3
DOIs	https://doi.org/10.1016/j.radonc.2009.02.003
Publication status	Published - Jun 2009
Externally published	Yes

Keywords

Adult
Chi-Square Distribution
Dose Fractionation, Radiation
Dose-Response Relationship, Radiation
Female
Humans
Incidence
Likelihood Functions
Lung Neoplasms/pathology
Male
Neoplasm Staging
Radiation Pneumonitis/epidemiology
Radiosurgery/methods
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Risk Factors
Treatment Outcome

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10.1016/j.radonc.2009.02.003

Cite this

Borst, G. R., Ishikawa, M., Nijkamp, J., Hauptmann, M., Shirato, H., Onimaru, R., van den Heuvel, M. M., Belderbos, J., Lebesque, J. V., & Sonke, J.-J. (2009). Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 91(3), 307-13. https://doi.org/10.1016/j.radonc.2009.02.003

@article{1eb3d59904034d82850fa50d945cad5f,

title = "Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy",

abstract = "PURPOSE: We evaluated the relationship between the mean lung dose (MLD) and the incidence of radiation pneumonitis (RP) after stereotactic body radiation therapy (SBRT), and compared this with conventional fractionated radiation therapy (CFRT).MATERIALS AND METHODS: For both SBRT (n=128) and CFRT (n=142) patients, RP grade > or = 2 was scored. Toxicity models predicting the probability of RP as a function of the MLD were fitted using maximum log likelihood analysis. The MLD was NTD (Normalized Total Dose) corrected using an alpha/beta ratio of 3 Gy.RESULTS: SBRT patients were treated with 6-12 Gy per fraction with a median MLD of 6.4 Gy (range: 1.5-26.5 Gy). CFRT patients were treated with 2 Gy or 2.25 Gy per fraction, the median MLD was 13.2 Gy (range: 3.0-23.0 Gy). The crude incidence rates of RP were 10.9\% and 17.6\% for the SBRT and CFRT patients, respectively. A significant dose-response relationship for RP was found after SBRT, which was not significantly different from the dose-response relationship for CFRT (p=0.18).CONCLUSION: We derived a significant dose-response relationship between the risk of RP and the MLD for SBRT from the clinical data. This relation was not significantly different from the dose-response relation for CFRT, although statistical analysis was hampered by the low number of patients in the high dose range.",

keywords = "Adult, Chi-Square Distribution, Dose Fractionation, Radiation, Dose-Response Relationship, Radiation, Female, Humans, Incidence, Likelihood Functions, Lung Neoplasms/pathology, Male, Neoplasm Staging, Radiation Pneumonitis/epidemiology, Radiosurgery/methods, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Risk Factors, Treatment Outcome",

author = "Borst, \{Gerben R\} and Masayori Ishikawa and Jasper Nijkamp and Michael Hauptmann and Hiroki Shirato and Rikiya Onimaru and \{van den Heuvel\}, \{Michel M\} and Jose Belderbos and Lebesque, \{Joos V\} and Jan-Jakob Sonke",

year = "2009",

month = jun,

doi = "10.1016/j.radonc.2009.02.003",

language = "English",

volume = "91",

pages = "307--13",

journal = "Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

number = "3",

}

Borst, GR, Ishikawa, M, Nijkamp, J, Hauptmann, M, Shirato, H, Onimaru, R, van den Heuvel, MM, Belderbos, J, Lebesque, JV & Sonke, J-J 2009, 'Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy', Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, vol. 91, no. 3, pp. 307-13. https://doi.org/10.1016/j.radonc.2009.02.003

Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy. / Borst, Gerben R; Ishikawa, Masayori; Nijkamp, Jasper et al.
In: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Vol. 91, No. 3, 06.2009, p. 307-13.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy

AU - Borst, Gerben R

AU - Ishikawa, Masayori

AU - Nijkamp, Jasper

AU - Hauptmann, Michael

AU - Shirato, Hiroki

AU - Onimaru, Rikiya

AU - van den Heuvel, Michel M

AU - Belderbos, Jose

AU - Lebesque, Joos V

AU - Sonke, Jan-Jakob

PY - 2009/6

Y1 - 2009/6

N2 - PURPOSE: We evaluated the relationship between the mean lung dose (MLD) and the incidence of radiation pneumonitis (RP) after stereotactic body radiation therapy (SBRT), and compared this with conventional fractionated radiation therapy (CFRT).MATERIALS AND METHODS: For both SBRT (n=128) and CFRT (n=142) patients, RP grade > or = 2 was scored. Toxicity models predicting the probability of RP as a function of the MLD were fitted using maximum log likelihood analysis. The MLD was NTD (Normalized Total Dose) corrected using an alpha/beta ratio of 3 Gy.RESULTS: SBRT patients were treated with 6-12 Gy per fraction with a median MLD of 6.4 Gy (range: 1.5-26.5 Gy). CFRT patients were treated with 2 Gy or 2.25 Gy per fraction, the median MLD was 13.2 Gy (range: 3.0-23.0 Gy). The crude incidence rates of RP were 10.9% and 17.6% for the SBRT and CFRT patients, respectively. A significant dose-response relationship for RP was found after SBRT, which was not significantly different from the dose-response relationship for CFRT (p=0.18).CONCLUSION: We derived a significant dose-response relationship between the risk of RP and the MLD for SBRT from the clinical data. This relation was not significantly different from the dose-response relation for CFRT, although statistical analysis was hampered by the low number of patients in the high dose range.

AB - PURPOSE: We evaluated the relationship between the mean lung dose (MLD) and the incidence of radiation pneumonitis (RP) after stereotactic body radiation therapy (SBRT), and compared this with conventional fractionated radiation therapy (CFRT).MATERIALS AND METHODS: For both SBRT (n=128) and CFRT (n=142) patients, RP grade > or = 2 was scored. Toxicity models predicting the probability of RP as a function of the MLD were fitted using maximum log likelihood analysis. The MLD was NTD (Normalized Total Dose) corrected using an alpha/beta ratio of 3 Gy.RESULTS: SBRT patients were treated with 6-12 Gy per fraction with a median MLD of 6.4 Gy (range: 1.5-26.5 Gy). CFRT patients were treated with 2 Gy or 2.25 Gy per fraction, the median MLD was 13.2 Gy (range: 3.0-23.0 Gy). The crude incidence rates of RP were 10.9% and 17.6% for the SBRT and CFRT patients, respectively. A significant dose-response relationship for RP was found after SBRT, which was not significantly different from the dose-response relationship for CFRT (p=0.18).CONCLUSION: We derived a significant dose-response relationship between the risk of RP and the MLD for SBRT from the clinical data. This relation was not significantly different from the dose-response relation for CFRT, although statistical analysis was hampered by the low number of patients in the high dose range.

KW - Adult

KW - Chi-Square Distribution

KW - Dose Fractionation, Radiation

KW - Dose-Response Relationship, Radiation

KW - Female

KW - Humans

KW - Incidence

KW - Likelihood Functions

KW - Lung Neoplasms/pathology

KW - Male

KW - Neoplasm Staging

KW - Radiation Pneumonitis/epidemiology

KW - Radiosurgery/methods

KW - Radiotherapy Dosage

KW - Radiotherapy Planning, Computer-Assisted

KW - Risk Factors

KW - Treatment Outcome

U2 - 10.1016/j.radonc.2009.02.003

DO - 10.1016/j.radonc.2009.02.003

M3 - Article

C2 - 19321217

SN - 0167-8140

VL - 91

SP - 307

EP - 313

JO - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

JF - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

IS - 3

ER -

Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy

Abstract

Keywords

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