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Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies.
- Source :
-
International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2016 Aug 01; Vol. 95 (5), pp. 1357-1366. Date of Electronic Publication: 2016 Mar 25. - Publication Year :
- 2016
-
Abstract
- Purpose: To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiation therapy (SBRT) of the thorax.<br />Methods and Materials: Published studies on lung toxicity in patients with early-stage non-small cell lung cancer (NSCLC) or metastatic lung tumors treated with SBRT were pooled and analyzed. The primary endpoint was RILT, including pneumonitis and fibrosis. Data of RILT and risk factors were extracted from each study, and rates of grade 2 to 5 (G2+) and grade 3 to 5 (G3+) RILT were computed. Patient, tumor, and dosimetric factors were analyzed for their correlation with RILT.<br />Results: Eighty-eight studies (7752 patients) that reported RILT incidence were eligible. The pooled rates of G2+ and G3+ RILT from all 88 studies were 9.1% (95% confidence interval [CI]: 7.15-11.4) and 1.8% (95% CI: 1.3-2.5), respectively. The median of median tumor sizes was 2.3 (range, 1.4-4.1) cm. Among the factors analyzed, older patient age (P=.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ (P=.049) and G3+ RILT (P=.001). Patients with stage IA versus stage IB NSCLC had significantly lower risks of G2+ RILT (8.3% vs 17.1%, odds ratio = 0.43, 95% CI: 0.29-0.64, P<.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) (P=.027) and V20 (P=.019) in patients with G2+ RILT than in those with grade 0 to 1 RILT.<br />Conclusions: The overall rate of RILT is relatively low after thoracic SBRT. Older age and larger tumor size are significant adverse risk factors for RILT. Lung dosimetry, specifically lung V20 and MLD, also significantly affect RILT risk.<br /> (Copyright © 2016. Published by Elsevier Inc.)
- Subjects :
- Age Distribution
Aged
Aged, 80 and over
Causality
Comorbidity
Dose-Response Relationship, Radiation
Female
Humans
Incidence
Lung Neoplasms diagnosis
Male
Middle Aged
Radiation Pneumonitis diagnosis
Radiotherapy Dosage
Reproducibility of Results
Risk Factors
Sensitivity and Specificity
Treatment Outcome
Carcinoma, Non-Small-Cell Lung mortality
Carcinoma, Non-Small-Cell Lung radiotherapy
Lung Neoplasms epidemiology
Lung Neoplasms radiotherapy
Radiation Pneumonitis epidemiology
Radiosurgery statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1879-355X
- Volume :
- 95
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- International journal of radiation oncology, biology, physics
- Publication Type :
- Academic Journal
- Accession number :
- 27325482
- Full Text :
- https://doi.org/10.1016/j.ijrobp.2016.03.024