title: Low incidence of chest wall pain with a risk-adapted lung stereotactic body radiation therapy approach using three or five fractions based on chest wall dosimetry.
abstract: OBJECTIVE
  To examine the frequency and potential of dose-volume predictors for chest wall (CW) toxicity (pain and/or rib fracture) for patients receiving lung stereotactic body radiotherapy (SBRT) using treatment planning methods to minimize CW dose and a risk-adapted fractionation scheme.
  
  
  METHODS
  We reviewed data from 72 treatment plans, from 69 lung SBRT patients with at least one year of follow-up or CW toxicity, who were treated at our center between 2010 and 2013. Treatment plans were optimized to reduce CW dose and patients received a risk-adapted fractionation of 18 Gy×3 fractions (54 Gy total) if the CW V30 was less than 30 mL or 10-12 Gy×5 fractions (50-60 Gy total) otherwise. The association between CW toxicity and patient characteristics, treatment parameters and dose metrics, including biologically equivalent dose, were analyzed using logistic regression.
  
  
  RESULTS
  With a median follow-up of 20 months, 6 (8.3%) patients developed CW pain including three (4.2%) grade 1, two (2.8%) grade 2 and one (1.4%) grade 3. Five (6.9%) patients developed rib fractures, one of which was symptomatic. No significant associations between CW toxicity and patient and dosimetric variables were identified on univariate nor multivariate analysis.
  
  
  CONCLUSIONS
  Optimization of treatment plans to reduce CW dose and a risk-adapted fractionation strategy of three or five fractions based on the CW V30 resulted in a low incidence of CW toxicity. Under these conditions, none of the patient characteristics or dose metrics we examined appeared to be predictive of CW pain.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, United States of America; Joseph Fourier University, Department of Engineering for Health and Medicine, Grenoble, France.
authors.forename: Thibaud P
authors.initials: TP
authors.lastname: Coroller
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Mak
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: John H
authors.initials: JH
authors.lastname: Lewis
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Baldini
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Aileen B
authors.initials: AB
authors.lastname: Chen
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Yolonda L
authors.initials: YL
authors.lastname: Colson
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Fred L
authors.initials: FL
authors.lastname: Hacker
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Hermann
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Kozono
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Edward
authors.initials: E
authors.lastname: Mannarino
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Christina
authors.initials: C
authors.lastname: Molodowitch
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Jon O
authors.initials: JO
authors.lastname: Wee
authors.affiliation: Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois, United States of America.
authors.forename: David J
authors.initials: DJ
authors.lastname: Sher
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Killoran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011829:Radiation Dosage; D011859:Radiography; D011874:Radiometry; D016634:Radiosurgery / Q000009:adverse effects*; D012253:Rib Fractures / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D035441:Thoracic Wall / Q000000981:diagnostic imaging*
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