title: Correlation of dosimetric parameters obtained with the analytical anisotropic algorithm and toxicity of chest chemoradiation in lung carcinoma.
abstract: The purpose of this study was to analyze and revisit toxicity related to chest chemoradiotherapy and to correlate these side effects with dosimetric parameters obtained using analytical anisotropic algorithm (AAA) in locally unresectable advanced lung cancer. We retrospectively analyzed data from 47 lung cancer patients between 2005 and 2008. All received conformal 3D radiotherapy using high-energy linear accelerator plus concomitant chemotherapy. All treatment planning data were transferred into Eclipse 8.05 (Varian Medical Systems, Palo Alto, CA) and dosimetric calculations were performed using AAA. Thirty-three patients (70.2%) developed acute pneumopathy after radiotherapy (grades 1 and 2). One patient (2.1%) presented with grade 3 pneumopathy. Thirty-one (66%) presented with grades 1-2 lung fibrosis, and 1 patient presented with grade 3 lung fibrosis. Thirty-four patients (72.3%) developed grade 1-2 acute oesophagic toxicity. Four patients (8.5%) presented with grades 3 and 4 dysphagia, necessitating prolonged parenteral nutrition. Median prescribed dose was 64 Gy (range 50-74) with conventional fractionation (2 Gy per fraction). Dose-volume constraints were respected with a median V20 of 23.5% (maximum 34%) and a median V30 of 17% (maximum 25%). The median dose delivered to healthy contralateral lung was 13.1 Gy (maximum 18.1 Gy). At univariate analysis, larger planning target volume and V20 were significantly associated with the probability of grade ≥2 radiation-induced pneumopathy (p = 0.022 and p = 0.017, respectively). No relation between oesophagic toxicity and clinical/dosimetric parameters could be established. Using AAA, the present results confirm the predictive value of the V20 for lung toxicity as already demonstrated with the conventional pencil beam convolution approach.
authors.affiliation: Dèpartement de Radiothérapie, Institut de Cancérologie de la Loire, St-Priest en Jarez, France.
authors.forename: Lysian
authors.initials: L
authors.lastname: Cartier
authors.forename: Pierre
authors.initials: P
authors.lastname: Auberdiac
authors.forename: Mustapha
authors.initials: M
authors.lastname: Khodri
authors.forename: Nadia
authors.initials: N
authors.lastname: Malkoun
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.forename: Julie
authors.initials: J
authors.lastname: Thorin
authors.forename: Adrien
authors.initials: A
authors.lastname: Mélis
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Talabard
authors.forename: Guy
authors.initials: G
authors.lastname: de Laroche
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournel
authors.forename: Olivier
authors.initials: O
authors.lastname: Tiffet
authors.forename: Thierry
authors.initials: T
authors.lastname: Schmitt
authors.forename: Nicolas
authors.initials: N
authors.lastname: Magné
mesh_terms: D000465:Algorithms; D002277:Carcinoma / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies