title: Relationship between dose-volume parameters and pulmonary complications after neoadjuvant chemoradiotherapy followed by surgery for lung cancer.
abstract: OBJECTIVE
  This study evaluated the relationship between dose-volume histogram (DVH) parameters and pulmonary complications after neoadjuvant chemoradiotherapy (NACRT) followed by surgery for lung cancer. We also examined a new DVH parameter, because the unresected lung should be more spared than the later resected lung.
  
  
  METHODS
  Data from 43 non-small cell lung cancer patients were retrospectively analyzed. The DVH parameters of the lung were calculated from the total bilateral lung volume minus (1) the gross tumor volume (DVHg) or (2) the later resected lung volume (DVHr). Radiation pneumonitis (RP) and fistula, including bronchopleural and pulmonary fistula, were graded as the pulmonary complications. Factors affecting the incidences of grade 2 or higher RP (≥G2 RP) and fistula were analyzed.
  
  
  RESULTS
  Sixteen patients (37 %) experienced ≥G2 RP and a V20 value of the total lung minus the later resected lung (V20r) ≥ 12 % was a significant factor affecting the incidence of ≥G2 RP (p = 0.032). Six patients (14 %) developed a fistula and a V35 value of the total lung minus the gross tumor (V35g) ≥ 19 % and a V40g ≥ 16 % were significant factors affecting the incidence of fistula (p = 0.002 and 0.009, respectively).
  
  
  CONCLUSIONS
  These DVH parameters may be related to the incidences of ≥G2 RP and fistula.
authors.affiliation: Department of Radiation Oncology, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, 761-0793, Kagawa, Japan. shigeot@med.kagawa-u.ac.jp.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of General Thoracic, Breast and Endocrine Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Tetsuhiko
authors.initials: T
authors.lastname: Go
authors.affiliation: Department of General Thoracic, Breast and Endocrine Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kasai
authors.affiliation: Department of General Thoracic, Breast and Endocrine Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Yokomise
authors.affiliation: Department of Radiation Oncology, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, 761-0793, Kagawa, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Shibata
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D000069079:Radiation Exposure / Q000032:analysis; D017564:Radiation Pneumonitis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D011879:Radiotherapy Dosage; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden / Q000528:radiation effects
keywords: Fistula; Morbidity; Non-small cell lung cancer; Radiation pneumonitis; Toxicity