title: Dose-volume parameters predict for the development of chest wall pain after stereotactic body radiation for lung cancer.
abstract: OBJECTIVE
  Chest wall (CW) pain has recently been recognized as an important adverse effect of stereotactic body radiation therapy (SBRT) for non-small-cell lung cancer (NSCLC). We developed a dose-volume model to predict the development of this toxicity.
  
  
  METHODS
  A total of 126 patients with primary, clinically node-negative NSCLC received three to five fractions of SBRT to doses of 40-60 Gy and were prospectively followed. The dose-absolute volume histograms of two different definitions of the CW as an organ at risk (CW3cm and CW2cm) were examined for all 126 patients.
  
  
  RESULTS
  With a median follow-up of 16 months, the 2-year estimated actuarial incidence of Grade ≥ 2 CW pain was 39%. The median time to onset of Grade ≥ 2 CW pain (National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0) was 9 months. There was no predictive advantage for biologically corrected dose over physical dose. Neither fraction number (p = 0.07) nor prescription dose (p = 0.07) were significantly correlated with the development of Grade ≥ 2 CW pain. Cox Proportional Hazards analysis identified significant correlation with a broad range of dose-volume combinations, with the CW volume receiving 30 Gy (V30) as one of the strongest predictors (p < 0.001). CW2cm consistently enabled better prediction of CW toxicity. When a physical dose of 30 Gy was received by more than 70 cm(3) of CW2cm, there was a significant correlation with Grade ≥ 2 CW pain (p = 0.004).
  
  
  CONCLUSIONS
  CW toxicity after SBRT is common and long-term follow-up is needed to identify affected patients. A volume of CW ≥ 70 cm(3) receiving 30 Gy is significantly correlated with Grade ≥ 2 CW pain. We are currently applying this constraint at our institution for patients receiving thoracic SBRT. An actuarial atlas of our data is provided as an electronic supplement to facilitate data-sharing and meta-analysis relating to CW pain.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Mutter
authors.forename: Fan
authors.initials: F
authors.lastname: Liu
authors.forename: Andres
authors.initials: A
authors.lastname: Abreu
authors.forename: Ellen
authors.initials: E
authors.lastname: Yorke
authors.forename: Andrew
authors.initials: A
authors.lastname: Jackson
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Rosenzweig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D002637:Chest Pain / Q000209:etiology*; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000293:injuries / Q000528:radiation effects; D010147:Pain Measurement / Q000379:methods; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011832:Radiation Injuries / Q000150:complications*; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D012272:Ribs / Q000293:injuries / Q000528:radiation effects; D035441:Thoracic Wall / Q000528:radiation effects*; D047368:Tumor Burden