Acute skin toxicity following stereotactic body radiation therapy for stage I non-small-cell lung cancer: who's at risk?
OBJECTIVE
We examined the rate of acute skin toxicity within a prospectively managed database of patients treated for early-stage non-small-cell lung cancer (NSCLC) and investigated factors that might predict skin toxicity.


METHODS
From May 2006 through January 2008, 50 patients with Stage I NSCLC were treated at Memorial Sloan-Kettering Cancer Center with 60 Gy in three fractions or 44-48 Gy in four fractions. Patients were treated with multiple coplanar beams (3-7, median 4) with a 6 MV linac using intensity-modulated radiotherapy (IMRT) and dynamic multileaf collimation. Toxicity grading was performed and based on the National Cancer Institute Common Terminology Criteria for Adverse Effects. Factors associated with Grade 2 or higher acute skin reactions were calculated by Fisher's exact test.


RESULTS
After a minimum 3 months of follow-up, 19 patients (38%) developed Grade 1, 4 patients (8%) Grade 2, 2 patients (4%) Grade 3, and 1 patient Grade 4 acute skin toxicity. Factors associated with Grade 2 or higher acute skin toxicity included using only 3 beams (p = 0.0007), distance from the tumor to the posterior chest wall skin of less than 5 cm (p = 0.006), and a maximum skin dose of 50% or higher of the prescribed dose (p = 0.02).


CONCLUSIONS
SBRT can be associated with significant skin toxicity. One must consider the skin dose when evaluating the treatment plan and consider the bolus effect of immobilization devices.
Hoppe
Bradford S
BS
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Laser
Benjamin
B
Kowalski
Alex V
AV
Fontenla
Sandra C
SC
Pena-Greenberg
Elizabeth
E
Yorke
Ellen D
ED
Lovelock
D Michael
DM
Hunt
Margie A
MA
Rosenzweig
Kenneth E
KE
D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D009336:Necrosis; D009367:Neoplasm Staging; D010347:Patient Care Planning; D011379:Prognosis; D016634:Radiosurgery / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D018570:Risk Assessment; D012867:Skin / Q000473:pathology* / Q000528:radiation effects*