title: Factors associated with chest wall toxicity after accelerated partial breast irradiation using high-dose-rate brachytherapy.
abstract: OBJECTIVE
  The purpose of this analysis was to evaluate dose-volume relationships associated with a higher probability for developing chest wall toxicity (pain) after accelerated partial breast irradiation (APBI) by using both single-lumen and multilumen brachytherapy.
  
  
  METHODS
  Rib dose data were available for 89 patients treated with APBI and were correlated with the development of chest wall/rib pain at any point after treatment. Ribs were contoured on computed tomography planning scans, and rib dose-volume histograms (DVH) along with histograms for other structures were constructed. Rib DVH data for all patients were sampled at all volumes ≥0.008 cubic centimeter (cc) (for maximum dose related to pain) and at volumes of 0.5, 1, 2, and 3 cc for analysis. Rib pain was evaluated at each follow-up visit. Patient responses were marked as yes or no. No attempt was made to grade responses. Eighty-nine responses were available for this analysis.
  
  
  RESULTS
  Nineteen patients (21.3%) complained of transient chest wall/rib pain at any point in follow-up. Analysis showed a direct correlation between total dose received and volume of rib irradiated with the probability of developing rib/chest wall pain at any point after follow-up. The median maximum dose at volumes ≥0.008 cc of rib in patients who experienced chest wall pain was 132% of the prescribed dose versus 95% of the prescribed dose in those patients who did not experience pain (p = 0.0035).
  
  
  CONCLUSIONS
  Although the incidence of chest wall/rib pain is quite low with APBI brachytherapy, attempts should be made to keep the volume of rib irradiated at a minimum and the maximum dose received by the chest wall as low as reasonably achievable.
authors.affiliation: Department of Radiation Oncology, WellStar Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Sheree
authors.initials: S
authors.lastname: Brown
authors.forename: Frank
authors.initials: F
authors.lastname: Vicini
authors.forename: Jyotsna R
authors.initials: JR
authors.lastname: Vanapalli
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Whitaker
authors.forename: D Keith
authors.initials: DK
authors.lastname: Pope
authors.forename: Maureen
authors.initials: M
authors.lastname: Lyden
authors.forename: Lisa
authors.initials: L
authors.lastname: Bruggeman
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Haile
authors.forename: Mark P
authors.initials: MP
authors.lastname: McLaughlin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D002637:Chest Pain / Q000209:etiology* / Q000517:prevention & control; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D012272:Ribs / Q000528:radiation effects*; D035441:Thoracic Wall / Q000528:radiation effects*