Predictors of chest wall toxicity after stereotactic ablative radiotherapy using real-time tumor tracking for lung tumorsReportar como inadecuado




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Radiation Oncology

, 12:66

First Online: 05 April 2017Received: 13 January 2017Accepted: 26 March 2017DOI: 10.1186-s13014-017-0803-2

Cite this article as: Park, Y., Kim, H.J. & Chang, A.R. Radiat Oncol 2017 12: 66. doi:10.1186-s13014-017-0803-2

Abstract

BackgroundTo evaluate the incidence of chest wall toxicity after lung stereotactic ablative radiotherapy SABR and identify risk factors for the development of rib fracture.

MethodsThirty-nine patients with 49 lesions underwent SABR for primary or metastatic lung tumors using Cyberknife® with tumor tracking systems. Patient characteristics, treatment factors and variables obtained from dose-volume histograms DVHs were analyzed to find the association with chest wall toxicity. Four-dimensional 4D dose calculations were done to investigate the effect of respiratory motion on dose to the ribs.

ResultsAfter follow-up of median 26.7 months range: 8.4 – 80.0, 8 patients 20.5% experienced rib fractures and among these patients, three 37.5% had chest wall pain at 2–3 months after SABR. Median time to rib fracture was 13.4 months range: 8.0 – 38.5 and the 2-year actuarial risk of rib fracture was 12.2%. Dose to the 4.6 cc of the ribs D4.6cc and rib volume received 160 Gy or more V160 were significant predictor for rib fracture. No significant differences between three-dimensional 3D and 4D dose calculations were found.

ConclusionsParameters from DVH are useful in predicting the risk of chest wall toxicity after SABR for lung tumors. Efforts should be made to reduce the risk of the rib fracture after lung SABR.

KeywordsStereotactic ablative radiotherapy Lung tumor Chest wall toxicity Rib fracture Dose-volume histogram 4D dose calculation Abbreviations3D3-dimensional

4D4-dimensional

AUCAreas under the curves

CTComputed tomography

DmaxMaximum point dose of irradiated rib

DVAbsolute dose received by rib volumes of V

DVHDose-volume histogram

EQD22 Gy equivalent dose

GTVGross tumor volume

PTVPlanning target volume

RIRFRadiation induced rib fracture

SABRStereotactic ablative body radiotherapy

VDAbsolute rib volume receiving a threshold dose D

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Autor: Younghee Park - Hee Jung Kim - Ah Ram Chang

Fuente: https://link.springer.com/







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