Organs at Risk Considerations for Thoracic Stereotactic Body Radiation Therapy: What Is Safe for Lung Parenchyma?

Abstract

PURPOSE:

Stereotactic body radiation therapy (SBRT) has become the standard of care for inoperable early-stage non-small cell lung cancer and is often used for recurrent lung cancer and pulmonary metastases. Radiation-induced lung toxicity (RILT), including radiation pneumonitis and pulmonary fibrosis, is a major concern for which it is important to understand dosimetric and clinical predictors.

METHODS AND MATERIALS:

This study was undertaken through the American Association of Physicists in Medicine's Working Group on Biological Effects of Stereotactic Body Radiotherapy. Data from studies of lung SBRT published through the summer of 2016 that provided detailed information about RILT were analyzed.

RESULTS:

Ninety-seven studies were ultimately considered. Definitions of the risk organ and complication endpoints as well as dose-volume information presented varied among studies. The risk of RILT, including radiation pneumonitis and pulmonary fibrosis, was reported to be associated with the size and location of the tumor. Patients with interstitial lung disease appear to be especially susceptible to severe RILT. A variety of dosimetric parameters were reported to be associated with RILT. There was no apparent threshold "tolerance dose-volume" level. However, most studies noted safe treatment with a rate of symptomatic RILT of <10% to 15% after lung SBRT with a mean lung dose (MLD) of the combined lungs ≤8 Gy in 3 to 5 fractions and the percent of total lung volume receiving more than 20 Gy (V20) <10% to 15%.

CONCLUSIONS:

To allow more rigorous analysis of this complication, future studies should standardize reporting by including standardized endpoint and volume definitions and providing dose-volume information for all patients, with and without RILT.

• Authors: Feng-Ming Spring Kong, Vitali Moiseenko, Jing Zhao, Michael T Milano, Ling Li, Andreas Rimner, Shiva Das, X Allen Li, Moyed Miften, ZhongXing Liao, Mary Martel, Soren M Bentzen, Andrew Jackson, Jimm Grimm, Lawrence B Marks, Ellen Yorke
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 110 Issue 1 Pg. 172-187 (05 01 2021) ISSN: 1879-355X [Electronic] United States
• PMID: 30496880 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Review)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Topics

• Carcinoma, Non-Small-Cell Lung (diagnostic imaging, pathology, radiotherapy)
• Humans
• Lung (diagnostic imaging, radiation effects)
• Lung Neoplasms (diagnostic imaging, pathology, radiotherapy)
• Models, Biological
• Models, Theoretical
• Organs at Risk (radiation effects)
• Pulmonary Fibrosis (etiology)
• Radiation Pneumonitis (etiology)
• Radiation Tolerance
• Radiosurgery (adverse effects, methods)
• Radiotherapy Dosage
• Re-Irradiation
• Risk Factors
• Tumor Burden