Outcome and toxicity of stereotactic body radiotherapy with helical tomotherapy for inoperable lung tumor: analysis of Grade 5 radiation pneumonitis.
To analyze outcomes and toxicities of stereotactic body radiotherapy with helical tomotherapy (HT-SBRT) for inoperable lung tumors, the medical records of 30 patients with 31 lung tumors treated with HT-SBRT were reviewed. The 3-year local control, cause-specific survival and overall survival rates (LC, CCS and OS, respectively) were analyzed using the Kaplan-Meier method. Toxicities were graded using Common Terminology Criteria for Adverse Events ver. 4. To investigate the factors associated with Grade 5 radiation pneumonitis (G5 RP), several parameters were analyzed: (i) patient-specific factors (age, gross tumor volume and PTV, and the interstitial pulmonary shadow on pretreatment CT); and (ii) dosimetry-specific factors (conformity index, homogeneity index, mean lung dose, and V5, V10, V15, V20 and V25 of the total lungs). The median duration of observation for all patients was 36.5 months (range, 4-67 months). The 3-year LC, CCS and OS were 82, 84 and 77%, respectively. Regarding Grade 3 or higher toxicities, two patients (6.7%) developed G5 RP. GTV was significantly associated with G5 RP (P = 0.025), and there were non-significant but slight associations with developing G5 RP for V5 (P = 0.067) and PTV (P = 0.096). HT-SBRT led to standard values of LC, CCS and OS, but also caused a markedly higher incidence of G5 RP. It is essential to optimize patient selection so as to avoid severe radiation pneumonitis in HT-SBRT.
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
Norihiro
N
Aibe
Hideya
H
Yamazaki
Satoaki
S
Nakamura
Takuji
T
Tsubokura
Kana
K
Kobayashi
Naohiro
N
Kodani
Takuya
T
Nishimura
Haruumi
H
Okabe
Kei
K
Yamada
D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D003131:Combined Modality Therapy / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D017564:Radiation Pneumonitis / Q000145:classification* / Q000401:mortality*; D016634:Radiosurgery / Q000401:mortality*; D050397:Radiotherapy, Intensity-Modulated / Q000401:mortality*; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
SBRT; helical tomotherapy; lung cancer; severe radiation pneumonitis