title: Association between absolute volumes of lung spared from low-dose irradiation and radiation-induced lung injury after intensity-modulated radiotherapy in lung cancer: a retrospective analysis.
abstract: The aim of this study was to investigate the association between absolute volumes of lung spared from low-dose irradiation and radiation-induced lung injury (RILI) after intensity-modulated radiotherapy (IMRT) for lung cancer. The normal lung relative volumes receiving greater than 5, 10, 20 and 30 Gy (V5-30) mean lung dose (MLD), and absolute volumes spared from greater than 5, 10, 20 and 30 Gy (AVS5-30) for the bilateral and ipsilateral lungs of 83 patients were recorded. Any association of clinical factors and dose-volume parameters with Grade ≥2 RILI was analyzed. The median follow-up was 12.3 months; 18 (21.7%) cases of Grade 2 RILI, seven (8.4%) of Grade 3 and two (2.4%) of Grade 4 were observed. Univariate analysis revealed the located lobe of the primary tumor. V5, V10, V20, MLD of the ipsilateral lung, V5, V10, V20, V30 and MLD of the bilateral lung, and AVS5 and AVS10 of the ipsilateral lung were associated with Grade ≥2 RILI (P < 0.05). Multivariate analysis indicated AVS5 of the ipsilateral lung was prognostic for Grade ≥2 RILI (P = 0.010, OR = 0.272, 95% CI: 0.102-0.729). Receiver operating characteristic curves indicated Grade ≥2 RILI could be predicted using AVS5 of the ipsilateral lung (area under curve, 0.668; cutoff value, 564.9 cm(3); sensitivity, 60.7%; specificity, 70.4%). The incidence of Grade ≥2 RILI was significantly lower with AVS5 of the ipsilateral lung ≥564.9 cm(3) than with AVS5 < 564.9 cm(3) (P = 0.008). Low-dose irradiation relative volumes and MLD of the bilateral or ipsilateral lung were associated with Grade ≥2 RILI, and AVS5 of the ipsilateral lung was prognostic for Grade ≥2 RILI for lung cancer after IMRT.
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China Key Laboratory of Radiation Biology, Fujian Medical University, Fujian Province University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China.
authors.forename: Jinmei
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China Key Laboratory of Radiation Biology, Fujian Medical University, Fujian Province University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China.
authors.forename: Jinsheng
authors.initials: J
authors.lastname: Hong
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China Key Laboratory of Radiation Biology, Fujian Medical University, Fujian Province University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Zou
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China Key Laboratory of Radiation Biology, Fujian Medical University, Fujian Province University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China.
authors.forename: Wenlong
authors.initials: W
authors.lastname: Lv
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China.
authors.forename: Feibao
authors.initials: F
authors.lastname: Guo
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China.
authors.forename: Hualan
authors.initials: H
authors.lastname: Hong
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China Key Laboratory of Radiation Biology, Fujian Medical University, Fujian Province University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China ZWJ9090@126.com.
authors.forename: Weijian
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D055370:Lung Injury; D008175:Lung Neoplasms / Q000532:radiotherapy; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies
keywords: intensity-modulated radiotherapy; low-dose irradiation volume; lung cancer; radiation-induced lung injury