Exceptionally high incidence of symptomatic grade 2-5 radiation pneumonitis after stereotactic radiation therapy for lung tumors

Hideomi Yamashita, Keiichi Nakagawa, Naoki Nakamura, Hiroki Koyanagi, Masao Tago, Hiroshi Igaki, Kenshiro Shiraishi, Nakashi Sasano, Kuni Ohtomo, Hideomi Yamashita, Keiichi Nakagawa, Naoki Nakamura, Hiroki Koyanagi, Masao Tago, Hiroshi Igaki, Kenshiro Shiraishi, Nakashi Sasano, Kuni Ohtomo

Abstract

Background: To determine the usefulness of dose volume histogram (DVH) factors for predicting the occurrence of radiation pneumonitis (RP) after application of stereotactic radiation therapy (SRT) for lung tumors, DVH factors were measured before irradiation.

Methods: From May 2004 to April 2006, 25 patients were treated with SRT at the University of Tokyo Hospital. Eighteen patients had primary lung cancer and seven had metastatic lung cancer. SRT was given in 6-7 fields with an isocenter dose of 48 Gy in four fractions over 5-8 days by linear accelerator.

Results: Seven of the 25 patients suffered from RP of symptomatic grade 2-5 according to the NCI-CTC version 3.0. The overall incidence rate of RP grade2 or more was 29% at 18 months after completing SRT and three patients died from RP. RP occurred at significantly increased frequencies in patients with higher conformity index (CI) (p = 0.0394). Mean lung dose (MLD) showed a significant correlation with V5-V20 (irradiated lung volume) (p < 0.001) but showed no correlation with CI. RP did not statistically correlate with MLD. MLD had the strongest correlation with V5.

Conclusion: Even in SRT, when large volumes of lung parenchyma are irradiated to such high doses as the minimum dose within planning target volume, the incidence of lung toxicity can become high.

Figures

Figure 1
Figure 1
Computed tomography (CT) image of radiation pneumonitis (RP) (patient No. 11).
Figure 2
Figure 2
CT image of RP (patient No. 13).
Figure 3
Figure 3
Kaplan-Meier plot of time from treatment until RP grade2 to 5. There were seven patients: one had RP at 2 months, one at 3 months, one at 9 months, two at 5 months, and two at 6 months.
Figure 4
Figure 4
The correlation comparing the occurrence of RP grade 2 or more with MLD.
Figure 5
Figure 5
The correlation comparing the occurrence of RP grade 2 or more with V20-V50.
Figure 6
Figure 6
The correlation comparing the occurrence of RP grade 2 or more with CI.

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