Giuseppe Palma1, Serena Monti2, Ting Xu3, Emanuele Scifoni4, Pei Yang3, Stephen M Hahn3, Marco Durante5, Radhe Mohan6, Zhongxing Liao7, Laura Cella1. 1. National Research Council, Institute of Biostructures and Bioimaging, Napoli, Italy. 2. IRCCS SDN, Image Processing Department, Napoli, Italy. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Istituto Nazionale di Fisica Nucleare, Trento Institute for Fundamental Physics and Applications, Trento, Italy. 5. Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany; Technische Universität Darmstadt, Institut für Festkörperphysik, Darmstadt, Germany. 6. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas. 7. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: zliao@mdanderson.org.
Abstract
PURPOSE:Radiation pneumonitis (RP) is commonly associated with thoracic radiation therapy, and its incidence is related to dose and volume of the normal lung in the path of radiation. Our aim was to investigate dose patterns associated with RP in patients enrolled in a randomized trial of intensity modulated radiation therapy (IMRT) versus passive scattering proton therapy (PSPT) for locally advanced non-small cell lung cancer. METHODS: We analyzed 178 patients prospectively treated withPSPT or IMRTfor non-small cell lung cancer to a prescribed dose of 66 or 74Gy in conventional daily fractionation with concurrent chemotherapy. Forty patients (22%) developed clinically symptomatic RP. Voxel-based analysis of local dose differences was done with a nonparametric permutation test accounting for multiple comparisons. From the obtained 3-dimensional significance maps, we derived clusters of voxels that exhibited dose differences between groups at a statistical significance level of 0.05. RESULTS: The voxel-based analysis highlighted that (1) significant dose differences between patients with and without RP were found in the lower part of the lungs and in the heart and (2) the anatomic regions significantly spared by PSPT and the clusters in which doses were significantly correlated with RP development were disjoint. CONCLUSIONS: The analyzed trial data provide an unprecedented opportunity to substantiate previous hypotheses regarding the role of the heart and the lower lungs in the development of RP. Knowledge of this relationship between RP and thoracic regional radiosensitivity should be considered in clinical practice and in the design of future trials.
RCT Entities:
PURPOSE:Radiation pneumonitis (RP) is commonly associated with thoracic radiation therapy, and its incidence is related to dose and volume of the normal lung in the path of radiation. Our aim was to investigate dose patterns associated with RP in patients enrolled in a randomized trial of intensity modulated radiation therapy (IMRT) versus passive scattering proton therapy (PSPT) for locally advanced non-small cell lung cancer. METHODS: We analyzed 178 patients prospectively treated with PSPT or IMRT for non-small cell lung cancer to a prescribed dose of 66 or 74 Gy in conventional daily fractionation with concurrent chemotherapy. Forty patients (22%) developed clinically symptomatic RP. Voxel-based analysis of local dose differences was done with a nonparametric permutation test accounting for multiple comparisons. From the obtained 3-dimensional significance maps, we derived clusters of voxels that exhibited dose differences between groups at a statistical significance level of 0.05. RESULTS: The voxel-based analysis highlighted that (1) significant dose differences between patients with and without RP were found in the lower part of the lungs and in the heart and (2) the anatomic regions significantly spared by PSPT and the clusters in which doses were significantly correlated with RP development were disjoint. CONCLUSIONS: The analyzed trial data provide an unprecedented opportunity to substantiate previous hypotheses regarding the role of the heart and the lower lungs in the development of RP. Knowledge of this relationship between RP and thoracic regional radiosensitivity should be considered in clinical practice and in the design of future trials.
Authors: Harald Paganetti; Chris Beltran; Stefan Both; Lei Dong; Jacob Flanz; Keith Furutani; Clemens Grassberger; David R Grosshans; Antje-Christin Knopf; Johannes A Langendijk; Hakan Nystrom; Katia Parodi; Bas W Raaymakers; Christian Richter; Gabriel O Sawakuchi; Marco Schippers; Simona F Shaitelman; B K Kevin Teo; Jan Unkelbach; Patrick Wohlfahrt; Tony Lomax Journal: Phys Med Biol Date: 2021-02-26 Impact factor: 4.174
Authors: Laura Cella; Serena Monti; Maria Thor; Andreas Rimner; Joseph O Deasy; Giuseppe Palma Journal: Cancers (Basel) Date: 2021-07-25 Impact factor: 6.639