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Published in: Japanese Journal of Radiology 1/2012

01-01-2012 | Original article

Analysis of dose–volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT

Authors: Gaurav Kumar, Sheh Rawat, Abhishek Puri, Manoj Kumar Sharma, Pranav Chadha, Anand Giri Babu, Girigesh Yadav

Published in: Japanese Journal of Radiology | Issue 1/2012

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Abstract

Purpose

Multimodality therapy for esophageal cancer can cause various kinds of treatment-related sequelae, especially pulmonary toxicities. This prospective study aims to investigate the clinical and dosimetric parameters predicting lung injury in patients undergoing radiation therapy for esophageal cancer.

Methods

Forty-five esophageal cancer patients were prospectively analyzed. The pulmonary toxicities (or sequelae) were evaluated by comparing chest X-ray films, pulmonary function tests and symptoms caused by pulmonary damage before and after treatment. All patients were treated with either three-dimensional radiotherapy (3DCRT) or with intensity-modulated radiotherapy (IMRT). The planning dose volume histogram was used to compute the lung volumes receiving more than 5, 10, 20 and 30 Gy (V5, V10, V20, V30) and mean lung dose.

Results

V20 was larger in the IMRT group than in the 3DCRT group (p = 0.002). V20 (>15%) and V30 (>20%) resulted in a statistically significant increase in the occurrence of chronic pneumonitis (p = 0.03) and acute pneumonitis (p = 0.007), respectively.

Conclusions

The study signifies that a larger volume of lung receives lower doses because of multiple beam arrangement and a smaller volume of lung receives higher doses because of better dose conformity in IMRT plans. Acute pneumonitis correlates more with V30 values, whereas chronic pneumonitis was predominantly seen in patients with higher V20 values.
Literature
1.
go back to reference Al-Sarraf M, Martz K, Herskovic A, Leichman L, Brindle JS, Vaitkevicius VK, et al. Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: an intergroup study. J Clin Oncol. 1997;15:277–84.PubMed Al-Sarraf M, Martz K, Herskovic A, Leichman L, Brindle JS, Vaitkevicius VK, et al. Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: an intergroup study. J Clin Oncol. 1997;15:277–84.PubMed
2.
go back to reference Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous cell cancer of the oesophagus. N Engl J Med. 1997;337:161–7.PubMedCrossRef Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous cell cancer of the oesophagus. N Engl J Med. 1997;337:161–7.PubMedCrossRef
3.
go back to reference Herskovic A, Martz K, Al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992;326:1593–8.PubMedCrossRef Herskovic A, Martz K, Al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992;326:1593–8.PubMedCrossRef
4.
go back to reference Tucker SL, Liu HH, Wang S, Wei X, Liao Z, Komaki R, et al. Dose–volume modeling of the risk of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys. 2006;66:754–61.PubMedCrossRef Tucker SL, Liu HH, Wang S, Wei X, Liao Z, Komaki R, et al. Dose–volume modeling of the risk of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys. 2006;66:754–61.PubMedCrossRef
5.
go back to reference Lee HK, Vaporciyan AA, Cox JD, Tucker SL, Putnam JB Jr, Ajani JA, et al. Postoperative pulmonary complications after preoperative chemoradiation for esophageal carcinoma: correlation with pulmonary dose–volume histogram parameters. Int J Radiat Oncol Biol Phys. 2003;57:1317–22.PubMedCrossRef Lee HK, Vaporciyan AA, Cox JD, Tucker SL, Putnam JB Jr, Ajani JA, et al. Postoperative pulmonary complications after preoperative chemoradiation for esophageal carcinoma: correlation with pulmonary dose–volume histogram parameters. Int J Radiat Oncol Biol Phys. 2003;57:1317–22.PubMedCrossRef
6.
go back to reference Wang SL, Liao Z, Vaporciyan AA, Tucker SL, Liu H, Wei X, et al. Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys. 2006;64:692–9.PubMedCrossRef Wang SL, Liao Z, Vaporciyan AA, Tucker SL, Liu H, Wei X, et al. Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys. 2006;64:692–9.PubMedCrossRef
7.
go back to reference Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol. 2002;20:1167–74.PubMedCrossRef Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol. 2002;20:1167–74.PubMedCrossRef
8.
go back to reference Nutting CM, Bedford JL, Cosgrove VP, Tait DM, Dearnaley DP, Webb S, et al. A comparison of conformal and intensity-modulated techniques for oesophageal radiotherapy. Radiother Oncol. 2001;61:157–63.PubMedCrossRef Nutting CM, Bedford JL, Cosgrove VP, Tait DM, Dearnaley DP, Webb S, et al. A comparison of conformal and intensity-modulated techniques for oesophageal radiotherapy. Radiother Oncol. 2001;61:157–63.PubMedCrossRef
9.
go back to reference Bedford JL, Viviers L, Guzel Z, Childs PJ, Webb S, Tait DM, et al. A quantitative treatment planning study evaluating the potential of dose escalation in conformal radiotherapy of the oesophagus. Radiother Oncol. 2000;57:183–93.PubMedCrossRef Bedford JL, Viviers L, Guzel Z, Childs PJ, Webb S, Tait DM, et al. A quantitative treatment planning study evaluating the potential of dose escalation in conformal radiotherapy of the oesophagus. Radiother Oncol. 2000;57:183–93.PubMedCrossRef
10.
go back to reference Guzel Z, Bedford JL, Childs PJ, Nahum AE, Webb S, Oldham M, Tait D, et al. A comparison of conventional and conformal radiotherapy of the oesophagus: work in progress. Br J Radiol. 1998;71:1076–82.PubMed Guzel Z, Bedford JL, Childs PJ, Nahum AE, Webb S, Oldham M, Tait D, et al. A comparison of conventional and conformal radiotherapy of the oesophagus: work in progress. Br J Radiol. 1998;71:1076–82.PubMed
11.
go back to reference Nutting C, Dearnaley DP, Webb S. Intensity modulated radiation therapy: a clinical review. Br J Radiol. 2000;73:459–69.PubMed Nutting C, Dearnaley DP, Webb S. Intensity modulated radiation therapy: a clinical review. Br J Radiol. 2000;73:459–69.PubMed
12.
go back to reference Kutcher GJ, Burman C. Calculation of complication probability factors for non-uniform normal tissue irradiation: the effective volume method. Int J Radiat Oncol Biol Phys. 1989;16:1623–30.PubMedCrossRef Kutcher GJ, Burman C. Calculation of complication probability factors for non-uniform normal tissue irradiation: the effective volume method. Int J Radiat Oncol Biol Phys. 1989;16:1623–30.PubMedCrossRef
13.
go back to reference Lyman JT. Complication probability as assessed from dose–volume histograms. Radiat Res. 1985;104:S13–9.CrossRef Lyman JT. Complication probability as assessed from dose–volume histograms. Radiat Res. 1985;104:S13–9.CrossRef
14.
go back to reference Zaider M, Amols HI. A little to a lot or a lot to a little: is NTCP always minimized in multiport therapy? Int J Radiat Oncol Biol Phys. 1998;41:945–50.PubMedCrossRef Zaider M, Amols HI. A little to a lot or a lot to a little: is NTCP always minimized in multiport therapy? Int J Radiat Oncol Biol Phys. 1998;41:945–50.PubMedCrossRef
15.
go back to reference Seppenwoolde Y, Lebesque JV, de Jaeger K, Belderbos JS, Boersma LJ, Schilstra C, et al. Comparing different NTCP models that predict the incidence of radiation pneumonitis. Int J Radiat Oncol Biol Phys. 2003;55:724–35.PubMedCrossRef Seppenwoolde Y, Lebesque JV, de Jaeger K, Belderbos JS, Boersma LJ, Schilstra C, et al. Comparing different NTCP models that predict the incidence of radiation pneumonitis. Int J Radiat Oncol Biol Phys. 2003;55:724–35.PubMedCrossRef
16.
go back to reference Tsujino K, Hirota S, Endo M, Obayashi K, Kotani Y, Satouchi M, et al. Predictive value of dose–volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys. 2003;55:110–5.PubMedCrossRef Tsujino K, Hirota S, Endo M, Obayashi K, Kotani Y, Satouchi M, et al. Predictive value of dose–volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys. 2003;55:110–5.PubMedCrossRef
17.
go back to reference Kwa SL, Lebesque JV, Theuws JC, Marks LB, Munley MT, Bentel G, et al. Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys. 1998;42:1–9.PubMed Kwa SL, Lebesque JV, Theuws JC, Marks LB, Munley MT, Bentel G, et al. Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys. 1998;42:1–9.PubMed
18.
go back to reference Martel MK, Ten Haken RK, Hazuka MB, Turrisi AT, Fraass BA, Lichter AS, et al. Dose–volume histogram and 3-D treatment planning evaluation of patients with pneumonitis. Int J Radiat Oncol Biol Phys. 1994;28:575–81.PubMedCrossRef Martel MK, Ten Haken RK, Hazuka MB, Turrisi AT, Fraass BA, Lichter AS, et al. Dose–volume histogram and 3-D treatment planning evaluation of patients with pneumonitis. Int J Radiat Oncol Biol Phys. 1994;28:575–81.PubMedCrossRef
19.
go back to reference Söderström S, Brahme A. Which is the most suitable number of photon beam portals in coplanar radiation therapy? Int J Radiat Oncol Biol Phys. 1995;33:151–9.PubMedCrossRef Söderström S, Brahme A. Which is the most suitable number of photon beam portals in coplanar radiation therapy? Int J Radiat Oncol Biol Phys. 1995;33:151–9.PubMedCrossRef
20.
go back to reference Stein J, Mohan R, Wang XH, Bortfeld T, Wu Q, Preiser K, et al. Number and orientations of beams in intensity-modulated radiation treatments. Med Phys. 1997;24:149–60.PubMedCrossRef Stein J, Mohan R, Wang XH, Bortfeld T, Wu Q, Preiser K, et al. Number and orientations of beams in intensity-modulated radiation treatments. Med Phys. 1997;24:149–60.PubMedCrossRef
21.
go back to reference Common Terminology Criteria for Adverse Events Version 3 (CTCAE v3). Published in August 2006. Common Terminology Criteria for Adverse Events Version 3 (CTCAE v3). Published in August 2006.
22.
go back to reference Kam MK, Chau RM, Suen J, Choi PH, Teo PM. Intensity-modulated radiotherapy in nasopharyngeal carcinoma: dosimetric advantage over conventional plans and feasibility of dose escalation. Int J Radiat Oncol Biol Phys. 2003;56:145–57.PubMedCrossRef Kam MK, Chau RM, Suen J, Choi PH, Teo PM. Intensity-modulated radiotherapy in nasopharyngeal carcinoma: dosimetric advantage over conventional plans and feasibility of dose escalation. Int J Radiat Oncol Biol Phys. 2003;56:145–57.PubMedCrossRef
23.
go back to reference Gopal R, Tucker SL, Komaki R, Liao Z, Forster KM, Stevens C, et al. The relationship between local dose and loss of function for irradiated lung. Int J Radiat Oncol Biol Phys. 2003;56:106–13.PubMedCrossRef Gopal R, Tucker SL, Komaki R, Liao Z, Forster KM, Stevens C, et al. The relationship between local dose and loss of function for irradiated lung. Int J Radiat Oncol Biol Phys. 2003;56:106–13.PubMedCrossRef
24.
go back to reference Smith TJ, Ryan LM, Douglass HO Jr, Haller DG, Dayal Y, Kirkwood J, et al. Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys. 1998;42:269–76.PubMed Smith TJ, Ryan LM, Douglass HO Jr, Haller DG, Dayal Y, Kirkwood J, et al. Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys. 1998;42:269–76.PubMed
25.
go back to reference Sykes AJ, Burt PA, Slevin NJ, Stout R, Marrs JE. Radical radiotherapy for carcinoma of the oesophagus: an effective alternative to surgery. Radiother Oncol. 1998;48:15–21.PubMedCrossRef Sykes AJ, Burt PA, Slevin NJ, Stout R, Marrs JE. Radical radiotherapy for carcinoma of the oesophagus: an effective alternative to surgery. Radiother Oncol. 1998;48:15–21.PubMedCrossRef
26.
go back to reference Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996;335:462–7.PubMedCrossRef Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996;335:462–7.PubMedCrossRef
27.
go back to reference Marks LB, Munley MT, Bentel GC, Zhou SM, Hollis D, Scarfone C, et al. Physical and biological predictors of changes in whole-lung function following thoracic irradiation. Int J Radiat Oncol Biol Phys. 1997;39:563–70.PubMedCrossRef Marks LB, Munley MT, Bentel GC, Zhou SM, Hollis D, Scarfone C, et al. Physical and biological predictors of changes in whole-lung function following thoracic irradiation. Int J Radiat Oncol Biol Phys. 1997;39:563–70.PubMedCrossRef
28.
go back to reference Anscher MS, Kong FM, Marks LB, Bentel GC, Jirtle RL. Changes in plasma transforming growth factor beta during radiotherapy and the risk of symptomatic radiation-induced pneumonitis. Int J Radiat Oncol Biol Phys. 1997;37:253–8.PubMedCrossRef Anscher MS, Kong FM, Marks LB, Bentel GC, Jirtle RL. Changes in plasma transforming growth factor beta during radiotherapy and the risk of symptomatic radiation-induced pneumonitis. Int J Radiat Oncol Biol Phys. 1997;37:253–8.PubMedCrossRef
29.
go back to reference Anscher MS, Kong FM, Jirtle R. The relevance of transforming growth factor beta 1 in pulmonary injury after radiation therapy. Lung Cancer. 1998;19:109–20.PubMedCrossRef Anscher MS, Kong FM, Jirtle R. The relevance of transforming growth factor beta 1 in pulmonary injury after radiation therapy. Lung Cancer. 1998;19:109–20.PubMedCrossRef
30.
go back to reference Anscher MS, Kong FM, Andrews K. Plasma transforming growth factor b1 as a predictor of radiation pneumonitis. Int J Radiat Oncol Biol Phys. 1998;41:1029–35.PubMedCrossRef Anscher MS, Kong FM, Andrews K. Plasma transforming growth factor b1 as a predictor of radiation pneumonitis. Int J Radiat Oncol Biol Phys. 1998;41:1029–35.PubMedCrossRef
31.
go back to reference Graham MV, Purdy JA, Emami B, Harms W, Bosch W, Lockett MA, et al. Clinical dose–volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys. 1999;45:323–9.PubMed Graham MV, Purdy JA, Emami B, Harms W, Bosch W, Lockett MA, et al. Clinical dose–volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys. 1999;45:323–9.PubMed
32.
go back to reference Hernando ML, Marks LB, Bentel GC, Zhou SM, Hollis D, Das SK, et al. Radiation induced pulmonary toxicity: a dose–volume histogram analysis in 201 patients with lung cancer. Int J Radiat Oncol Biol Phys. 2001;51:650–9.PubMedCrossRef Hernando ML, Marks LB, Bentel GC, Zhou SM, Hollis D, Das SK, et al. Radiation induced pulmonary toxicity: a dose–volume histogram analysis in 201 patients with lung cancer. Int J Radiat Oncol Biol Phys. 2001;51:650–9.PubMedCrossRef
33.
go back to reference Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21:109–22.PubMed Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21:109–22.PubMed
34.
go back to reference Graham MV. Predicting radiation response [editorial]. Int J Radiat Oncol Biol Phys. 1997;39:561–2.PubMedCrossRef Graham MV. Predicting radiation response [editorial]. Int J Radiat Oncol Biol Phys. 1997;39:561–2.PubMedCrossRef
35.
go back to reference Graham MV, Drzymala RE, Jain NL. Confirmation of dose–volume histograms and normal tissue complication probability calculations to predict pulmonary complications after radiotherapy for lung cancer. Int J Radiat Oncol Biol Phys. 1994;30(Suppl 1):198. Graham MV, Drzymala RE, Jain NL. Confirmation of dose–volume histograms and normal tissue complication probability calculations to predict pulmonary complications after radiotherapy for lung cancer. Int J Radiat Oncol Biol Phys. 1994;30(Suppl 1):198.
36.
go back to reference Graham MV, Jain NL, Kahn MG, Drzymala RE, Purdy JA. Evaluation of an objective plan-evaluation model in the three-dimensional treatment of non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 1996;34:469–74.PubMedCrossRef Graham MV, Jain NL, Kahn MG, Drzymala RE, Purdy JA. Evaluation of an objective plan-evaluation model in the three-dimensional treatment of non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 1996;34:469–74.PubMedCrossRef
37.
go back to reference Oetzel D, Schraube P, Hensley F, Sroka-Pérez G, Menke M, Flentje M. Estimation of pneumonitis risk in three-dimensional treatment planning using dose–volume histogram analysis. Int J Radiat Oncol Biol Phys. 1995;33:455–60.PubMedCrossRef Oetzel D, Schraube P, Hensley F, Sroka-Pérez G, Menke M, Flentje M. Estimation of pneumonitis risk in three-dimensional treatment planning using dose–volume histogram analysis. Int J Radiat Oncol Biol Phys. 1995;33:455–60.PubMedCrossRef
38.
go back to reference Shi A, Zhu G, Wu H, Yu R, Li F, Xu B. Analysis of clinical and dosimetric factors associated with severe acute radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent chemotherapy and intensity-modulated radiotherapy. Radiat Oncol. 2010;5:1–8. Shi A, Zhu G, Wu H, Yu R, Li F, Xu B. Analysis of clinical and dosimetric factors associated with severe acute radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent chemotherapy and intensity-modulated radiotherapy. Radiat Oncol. 2010;5:1–8.
Metadata
Title
Analysis of dose–volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT
Authors
Gaurav Kumar
Sheh Rawat
Abhishek Puri
Manoj Kumar Sharma
Pranav Chadha
Anand Giri Babu
Girigesh Yadav
Publication date
01-01-2012
Publisher
Springer Japan
Published in
Japanese Journal of Radiology / Issue 1/2012
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI
https://doi.org/10.1007/s11604-011-0002-2

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