BACKGROUND AND PURPOSE: To determine a dose-effect relation for radiation induced rib fractures after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC). Automatic rib delineation has enabled the analysis of a large patient group. MATERIAL AND METHODS: Four-hundred and sixty-six patients with stage I/II NSCLC received SBRT with a median of 54Gy in 3 fractions. The optimal EQD2-corrected dose parameter to predict (a)symptomatic fractures was found using Cox regression. Three normal tissue complication probability (NTCP) models based on this optimal parameter were constructed: (1) at a median follow up (FU) of 26months, (2) for all data, with time to toxicity taken into account and (3) at a FU of 26months, excluding low dose ribs. RESULTS: The median time to fracture was 22 (range 5-51) months. Maximum rib dose best predicted fractures. The TD50 (dose with 50% complication) of the second NTCP model was 375Gy. The TD50 was significantly higher for the other models indicating an under-estimation of the dose effect at the median follow-up time and/or when excluding low dose ribs. CONCLUSIONS: The risk of symptomatic rib fractures after SBRT was significantly correlated to dose, and was <5% at 26months when Dmax<225Gy.
BACKGROUND AND PURPOSE: To determine a dose-effect relation for radiation induced rib fractures after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC). Automatic rib delineation has enabled the analysis of a large patient group. MATERIAL AND METHODS: Four-hundred and sixty-six patients with stage I/II NSCLC received SBRT with a median of 54Gy in 3 fractions. The optimal EQD2-corrected dose parameter to predict (a)symptomatic fractures was found using Cox regression. Three normal tissue complication probability (NTCP) models based on this optimal parameter were constructed: (1) at a median follow up (FU) of 26months, (2) for all data, with time to toxicity taken into account and (3) at a FU of 26months, excluding low dose ribs. RESULTS: The median time to fracture was 22 (range 5-51) months. Maximum rib dose best predicted fractures. The TD50 (dose with 50% complication) of the second NTCP model was 375Gy. The TD50 was significantly higher for the other models indicating an under-estimation of the dose effect at the median follow-up time and/or when excluding low dose ribs. CONCLUSIONS: The risk of symptomatic rib fractures after SBRT was significantly correlated to dose, and was <5% at 26months when Dmax<225Gy.
Authors: Caterina Puglisi; Raffaella Giuffrida; Giuseppina Borzì; Salvatore Illari; Francesco Paolo Caronia; Paolo Di Mattia; Cristina Colarossi; Gianluca Ferini; Emanuele Martorana; Giovanni Sette; Adriana Eramo; Aurelio Lorico; Alfio Di Grazia; Stefano Forte Journal: Front Oncol Date: 2022-05-12 Impact factor: 5.738
Authors: Rene Baumann; Mark K H Chan; Florian Pyschny; Susanne Stera; Bettina Malzkuhn; Stefan Wurster; Stefan Huttenlocher; Marcella Szücs; Detlef Imhoff; Christian Keller; Panagiotis Balermpas; Dirk Rades; Claus Rödel; Jürgen Dunst; Guido Hildebrandt; Oliver Blanck Journal: Front Oncol Date: 2018-05-17 Impact factor: 6.244
Authors: Hann-Hsiang Chao; Gilmer Valdes; Jose M Luna; Marina Heskel; Abigail T Berman; Timothy D Solberg; Charles B Simone Journal: J Appl Clin Med Phys Date: 2018-07-10 Impact factor: 2.102