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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

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          Abstract

          Purpose

          To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiotherapy (SBRT) of the thorax.

          Methods

          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 2-5 (G2+) and grade 3-5 (G3+) RILT were computed. Patient, tumor and dosimetric factors were analyzed for their correlation with RILT.

          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% 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= 0.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ ( P= 0.049) and G3+ RILT ( P= 0.001). Patients with stage IA vs. stage IB NSCLC had significantly lower risks of G2+ RILT (8.3% vs 17.1%, OR= 0.43, 95% CI: 0.29-0.64, P<0.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) ( P= 0.027) and V20 ( P= 0.019) in patients with G2+ RILT comparing to that of grade 0-1 RILT.

          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.

          Summary

          Risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiotherapy (SBRT) were analyzed from 88 published studies (7752 patients). The overall rate of RILT is relatively low after thoracic SBRT. Adverse risk factors for RILT after SBRT include older age, larger tumor size and greater lung dose-volume exposure as measured by mean lung dose and volume of lung receiving greater than 20 Gy.

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          Author and article information

          Journal
          7603616
          4036
          Int J Radiat Oncol Biol Phys
          Int. J. Radiat. Oncol. Biol. Phys.
          International journal of radiation oncology, biology, physics
          0360-3016
          1879-355X
          15 June 2017
          25 March 2016
          01 August 2016
          03 August 2017
          : 95
          : 5
          : 1357-1366
          Affiliations
          [1 ]Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, USA, 30912
          [2 ]Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 430030
          [3 ]Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065
          [4 ]Department of Shanghai Cancer Hospital, Fudan University, Shanghai, China, 200032
          [5 ]Department of Radiation Oncology, University of Colorado, Denver, CO 80045
          [6 ]Department of Radiation Oncology, Medical College of Wisconsin, Milwaukie, WI 53226
          [7 ]Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC 27514
          [8 ]Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065
          [9 ]Department of Radiation Oncology, MD Anderson Cancer Center at Cooper, Camden, New Jersey 08103
          [10 ]Bott Cancer Center, Holy Redeemer Hospital, Meadowbrook, PA 19046
          [11 ]Department of Radiation Oncology, University of Rochester, Rochester, NY14642
          Author notes
          Mailing address, telephone, facsimile, and e-mail for corresponding author: 821 St Sebastian St, Augusta, GA 30912. Tel: (706) 723-0030; Fax: (706) 721-1937; fkong@ 123456gru.edu
          Article
          PMC5541363 PMC5541363 5541363 nihpa875768
          10.1016/j.ijrobp.2016.03.024
          5541363
          27325482
          5d20e9f5-83b7-48dc-9f6b-6f8797f060d2
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