Dose-volume factors contributing to the incidence of radiation pneumonitis in non-small-cell lung cancer patients treated with three-dimensional conformal radiation therapy.
OBJECTIVE
To analyze acute lung toxicity data of non-small-cell lung cancer patients treated with three-dimensional conformal radiation therapy in terms of dosimetric variables, location of dose within subvolumes of the lungs, and models of normal-tissue complication probability (NTCP).


METHODS
Dose distributions of 49 non-small-cell lung cancer patients treated in a dose escalation protocol between 1992 and 1999 were analyzed (dose range: 57.6-81 Gy). Nine patients had RTOG Grade 3 or higher acute lung toxicity. Correlation with dosimetric and physical variables, as well as Lyman and parallel NTCP models, was assessed. Lungs were evaluated as a single structure, as superior and inferior halves (to assess significance of dose to upper and lower lungs), and as ipsilateral and contralateral lungs.


RESULTS
For the whole lung, Grade 3 or higher pneumonitis was significantly correlated (p <or= 0.05) with mean dose and Lyman and parallel model indices (d(eff) and f(dam)). It was significantly correlated with these indices and with V20 for the ipsilateral lung and with mean dose and d(eff) for the inferior half of the lungs. Dosimetric and NTCP model quantities for the superior half of the lungs and contralateral lung were not significantly correlated (p > 0.5 for superior lung indices, and >0.1 for contralateral lung indices studied).


CONCLUSIONS
For these patients, commonly used dosimetric and NTCP models are significantly correlated with >or= Grade 3 pneumonitis. Equivalently strong correlations are found in the lower portion of the lungs and the ipsilateral lung, but not in the upper portion or contralateral lung.
Yorke
Ellen D
ED
Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. yorkee@mskcc.org
Jackson
Andrew
A
Rosenzweig
Kenneth E
KE
Merrick
Scott A
SA
Gabrys
Dorota
D
Venkatraman
Ennapadam S
ES
Burman
Chandra M
CM
Leibel
Steven A
SA
Ling
C Clifton
CC
D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D006801:Humans; D008168:Lung / Q000033:anatomy & histology / Q000528:radiation effects*; D008175:Lung Neoplasms / Q000532:radiotherapy*; D017564:Radiation Pneumonitis / Q000209:etiology*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*