title: Acute skin toxicity following stereotactic body radiation therapy for stage I non-small-cell lung cancer: who's at risk?
abstract: 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.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Bradford S
authors.initials: BS
authors.lastname: Hoppe
authors.forename: Benjamin
authors.initials: B
authors.lastname: Laser
authors.forename: Alex V
authors.initials: AV
authors.lastname: Kowalski
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Fontenla
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pena-Greenberg
authors.forename: Ellen D
authors.initials: ED
authors.lastname: Yorke
authors.forename: D Michael
authors.initials: DM
authors.lastname: Lovelock
authors.forename: Margie A
authors.initials: MA
authors.lastname: Hunt
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Rosenzweig
mesh_terms: 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*