Developing Multivariable Normal Tissue Complication Probability Model to Predict the Incidence of Symptomatic Radiation Pneumonitis among Breast Cancer Patients

Tsair-Fwu Lee, Pei-Ju Chao, Liyun Chang, Hui-Min Ting, Yu-Jie Huang, Tsair-Fwu Lee, Pei-Ju Chao, Liyun Chang, Hui-Min Ting, Yu-Jie Huang

Abstract

Purpose: Symptomatic radiation pneumonitis (SRP), which decreases quality of life (QoL), is the most common pulmonary complication in patients receiving breast irradiation. If it occurs, acute SRP usually develops 4-12 weeks after completion of radiotherapy and presents as a dry cough, dyspnea and low-grade fever. If the incidence of SRP is reduced, not only the QoL but also the compliance of breast cancer patients may be improved. Therefore, we investigated the incidence SRP in breast cancer patients after hybrid intensity modulated radiotherapy (IMRT) to find the risk factors, which may have important effects on the risk of radiation-induced complications.

Methods: In total, 93 patients with breast cancer were evaluated. The final endpoint for acute SRP was defined as those who had density changes together with symptoms, as measured using computed tomography. The risk factors for a multivariate normal tissue complication probability model of SRP were determined using the least absolute shrinkage and selection operator (LASSO) technique.

Results: Five risk factors were selected using LASSO: the percentage of the ipsilateral lung volume that received more than 20-Gy (IV20), energy, age, body mass index (BMI) and T stage. Positive associations were demonstrated among the incidence of SRP, IV20, and patient age. Energy, BMI and T stage showed a negative association with the incidence of SRP. Our analyses indicate that the risk of SPR following hybrid IMRT in elderly or low-BMI breast cancer patients is increased once the percentage of the ipsilateral lung volume receiving more than 20-Gy is controlled below a limitation.

Conclusions: We suggest to define a dose-volume percentage constraint of IV20< 37% (or AIV20< 310cc) for the irradiated ipsilateral lung in radiation therapy treatment planning to maintain the incidence of SPR below 20%, and pay attention to the sequelae especially in elderly or low-BMI breast cancer patients. (AIV20: the absolute ipsilateral lung volume that received more than 20 Gy (cc).

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. (a) A sample breast cancer…
Fig 1. (a) A sample breast cancer treatment plan, (b) diagnosed with RP at 3 months after RT, (c) diagnosed with RP image fused with the original isodose curves.
Abbreviation: RP: radiation pneumonitis; RT: radiotherapy.
Fig 2. The receiver operating characteristic curves…
Fig 2. The receiver operating characteristic curves (ROC) of the five normal tissue complication probability models for symptomatic radiation pneumonitis in breast cancer patients treated with hybrid IMRT.
Five factors: IV20, energy, age, body mass index (BMI) and T stage.
Fig 3. The univariate logistic normal tissue…
Fig 3. The univariate logistic normal tissue complication probability models with (a) IV20 and (b) AIV20 for symptomatic radiation pneumonitis in breast cancer patients treated with hybrid IMRT.
Abbreviation: IV20: ipsilateral lung volume received >20Gy (%); AIV20: absolute ipsilateral lung volume received >20Gy (cc); IMRT: intensity modulated radiotherapy.

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