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Chest Wall Volume Receiving >30 Gy Predicts Risk of Severe Pain and/or Rib Fracture After Lung Stereotactic Body Radiotherapy

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Title: Chest Wall Volume Receiving >30 Gy Predicts Risk of Severe Pain and/or Rib Fracture After Lung Stereotactic Body Radiotherapy
Authors: Dunlap, Neal E.1, Cai, Jing1, Biedermann, Gregory B.1, Yang, Wensha1, Benedict, Stanley H.1, Sheng, Ke1, Schefter, Tracey E.2, Kavanagh, Brian D.2, Larner, James M.1 jml2p@virginia.edu
Source: International Journal of Radiation Oncology, Biology, Physics. Mar2010, Vol. 76 Issue 3, p796-801. 6p.
Subjects: Chest pain, Pain risk factors, Stereotaxic techniques, Rib diseases, Lung radiography, Bone fractures, Toxicology
Abstract: Purpose: To identify the dose–volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy. Methods and Materials: From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving ≥20, ≥30, ≥40, ≥50, and ≥60 Gy was determined and related to the risk of CW toxicity. Results: Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose–response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R2 = 0.9552). A volume threshold of 30 cm3 was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm3 receiving 30 Gy. Conclusion: The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to <30 cm3, if possible, to reduce the risk of toxicity without compromising tumor coverage. [Copyright &y& Elsevier]
Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Chest Wall Volume Receiving &gt;30 Gy Predicts Risk of Severe Pain and/or Rib Fracture After Lung Stereotactic Body Radiotherapy
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Dunlap%2C+Neal+E%2E%22&quot;&gt;Dunlap, Neal E.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Cai%2C+Jing%22&quot;&gt;Cai, Jing&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Biedermann%2C+Gregory+B%2E%22&quot;&gt;Biedermann, Gregory B.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Yang%2C+Wensha%22&quot;&gt;Yang, Wensha&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Benedict%2C+Stanley+H%2E%22&quot;&gt;Benedict, Stanley H.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sheng%2C+Ke%22&quot;&gt;Sheng, Ke&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Schefter%2C+Tracey+E%2E%22&quot;&gt;Schefter, Tracey E.&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kavanagh%2C+Brian+D%2E%22&quot;&gt;Kavanagh, Brian D.&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Larner%2C+James+M%2E%22&quot;&gt;Larner, James M.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;i&gt; jml2p@virginia.edu&lt;/i&gt;
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22International+Journal+of+Radiation+Oncology%2C+Biology%2C+Physics%22&quot;&gt;International Journal of Radiation Oncology, Biology, Physics&lt;/searchLink&gt;. Mar2010, Vol. 76 Issue 3, p796-801. 6p.
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose: To identify the dose–volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy. Methods and Materials: From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving ≥20, ≥30, ≥40, ≥50, and ≥60 Gy was determined and related to the risk of CW toxicity. Results: Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose–response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R2 = 0.9552). A volume threshold of 30 cm3 was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm3 receiving 30 Gy. Conclusion: The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to &lt;30 cm3, if possible, to reduce the risk of toxicity without compromising tumor coverage. [Copyright &amp;y&amp; Elsevier]
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  Data: &lt;i&gt;Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1016/j.ijrobp.2009.02.027
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        Text: English
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      – SubjectFull: Chest pain
        Type: general
      – SubjectFull: Pain risk factors
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      – SubjectFull: Stereotaxic techniques
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      – SubjectFull: Rib diseases
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      – SubjectFull: Bone fractures
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      – SubjectFull: Toxicology
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      – TitleFull: Chest Wall Volume Receiving >30 Gy Predicts Risk of Severe Pain and/or Rib Fracture After Lung Stereotactic Body Radiotherapy
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