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


CONCLUSIONS
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.
Yamashita
Hideomi
H
Department of Radiology, University of Tokyo Hospital, Japan. yamachan07291973@yahoo.co.jp
Nakagawa
Keiichi
K
Nakamura
Naoki
N
Koyanagi
Hiroki
H
Tago
Masao
M
Igaki
Hiroshi
H
Shiraishi
Kenshiro
K
Sasano
Nakashi
N
Ohtomo
Kuni
K
D000368:Aged; D000369:Aged, 80 and over; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010315:Particle Accelerators; D017564:Radiation Pneumonitis / Q000453:epidemiology* / Q000209:etiology*; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome