Constraints for symptomatic radiation pneumonitis of helical tomotherapy hypofractionated simultaneous multitarget radiotherapy for pulmonary metastasis from hepatocellular carcinoma.
This study was aimed to identify the clinical and dosimetric parameters that predict symptomatic radiation pneumonitis (SRP, radiation pneumonitis≥2 grade) in patients with pulmonary metastasis from hepatocellular carcinoma (HCC) after helical tomotherapy (HT) hypofractionated simultaneous multitarget radiotherapy.



62 patients with 407 pulmonary metastases from HCC were consecutively treated with HT. The median radiation dose was a 49.7Gy in 4.0Gy/fraction to 95% of the planning target volume (PTV). The associations between the clinical and dosimetric data and incidences of SRP were analyzed. The dose-pneumonitis relationship was analyzed based on Biologically Effective Dose (BED).



Univariate analysis showed that the gross tumor volume (GTV), PTV, median lung dose (MLD), the number of pulmonary metastatic lesions (NPML), and the percentage of non-target normal lung (NTNL) volume receiving more than a BED of 3-50Gy (VBED3-50) were associated with SRP. Multivariate logistic regression analysis showed that VBED20and NPML were significant parameters (both P<0.001) CONCLUSIONS: Our findings indicated that SRP can be predicted with NPML>5 and VBED20≥30.4% with the α/β ratio of 3Gy.
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Genlai
G
Lin
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Han
H
Xiao
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: zeng.zhaochong@zs-hospital.sh.cn.
Zhaochong
Z
Zeng
Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China.
Zhiyong
Z
Xu
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Jian
J
He
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Taiwei
T
Sun
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Jin
J
Liu
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Genwu
G
Guo
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Weixing
W
Ji
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Yong
Y
Hu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D000069473:Radiation Dose Hypofractionation; D017564:Radiation Pneumonitis / Q000209:etiology*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*
Helical tomotherapy; Hepatocellular carcinoma; Hypofractionated radiotherapy; Pulmonary metastases; Radiation pneumonitis