Abstract Objective To compare lung dose-volume histogram (DVH) parameters based on commonly used normal lung definitions, i.e., lungs-gross tumor volume (GTV), lungs-clinical target volume (CTV), and lungs-planning target volume (PTV), in three-dimensional conformal radiotherapy(3DCRT) and to determine to what extent they differ in predicting radiation pneumonitis (RP). MethodsA total of 147 non-small cell lung cancer patients treated with concurrent chemotherapy and 3DCRT from 2006 to 2010 were collected. RP was diagnosed according to RTOG criteria. Lung DVHs were generated with exclusion of GTV, CTV, or PTV. Independent-samples t test was used to compare DVH parameters based on different normal lung definitions, and the predictive values of these parameters for RP were evaluated with the receiver operating characteristic (ROC) curve. Results There were significant differences in minimum lethal dose (MLD) between lungs-GTV and lungs-CTV/lungs-PTV ((1.16±0.96) Gy vs. (3.45±1.43) Gy). The biggest difference in MLD for the same patient based on different definitions was 8.73 Gy. MLD based on lungs-GTV had a better predictive value for grades ≥2 and ≥3 RP than MLD based on lungs-CTV and lungs-PTV, with larger areas under the ROC curve (lungs-GTV:area=0.614, P=0.024;area=0.678, P=0.056;lungs-CTV:area=0.556, P=0.269;area=0.602, P=0.226;lungs-PTV:area=0.551, P=0.317;area=0.616, P=0.167). We drew a similar conclusion when analyzing lung V5-V50. Conclusions There are significant differences between DVH parameters based on various normal lung definitions, which cannot be neglected in the clinical setting. DVH parameters based on lungs-GTV may be the most accurate in predicting RP.
Wang Jin,Bao Yon,Zhuang Tingting et al. Differences and radiation pneumonitis prediction of lung dosimetric parameters based on three normal lung definitions in 3DCRT treatment planning[J]. Chinese Journal of Radiation Oncology, 2014, 23(5): 396-399.
Wang Jin,Bao Yon,Zhuang Tingting et al. Differences and radiation pneumonitis prediction of lung dosimetric parameters based on three normal lung definitions in 3DCRT treatment planning[J]. Chinese Journal of Radiation Oncology, 2014, 23(5): 396-399.
[1] 王谨,庄婷婷,何智纯,等. 非小细胞肺癌同期放化疗后重度急性放射性肺炎的预测因素[J].中华放射肿瘤学杂志,2012,355:2542-2550. [2] 王谨,包勇,庄婷婷,等.非小细胞肺癌同期放化疗后重度急性放射性肺炎的预测模型研究[J].中华放射肿瘤学杂志,2013,22:455-459. [3] Yorke ED, Jackson A, Rosenzweig KE, et al. Correlation of dosimetric factors and radiation pneumonitis for non-small-cell lung cancer patients in a recently completed dose escalation study. Int J Radiat Oncol Biol Phys,2005,63:672-682. [4] NCCN. Non-small cell lung cancer[DB/OL][2013-10-20]. http://www.nccn.org/ professionals/physician_gls/ f_guidelines.asp#site. [5] Graham MV, Purdy JA, Emami B, Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC)[J]. Int J Radiat Oncol Biol Phys,1999,45:323-329. [6] Marks LB, Bentzen SM, Deasy JO, et al. Radiation dose-volume effects in the lung[J]. Int J Radiat Oncol Biol Phys,2010,76(3 Suppl):S70-S76. [7] 庄婷婷,柳青,张黎,等.非小细胞肺癌同期放化疗后急性放射性肺炎DVH预测参数的研究[J].中华放射肿瘤学杂志,2009,18:443-447. [8] Wang W, Xu Y, Schipper M, et al. Effect of normal lung definition on lung dosimetry and lung toxicity prediction in radiation therapy treatment planning[J]. Int J Radiat Oncol Biol Phys,2013,86:956-963. [9] 李建成,陈诚,潘建基,等.不同肺体积定义对肺癌放疗剂量学的影响[J]. 肿瘤学杂志,2013,19:263-267. [10] Tucker SL, Jin H, Wei X, et al. Impact of toxicity grade and scoring system on the relationship between mean lung dose and risk of radiation pneumonitis in a large cohort of patients with non-small cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2010,77:691-698. [11] Kong FM, Hayman JA, Griffith KA, et al. Final toxicity results of a radiation-dose escalation study in patients with non-small-cell lung cancer (NSCLC):predictors for radiation pneumonitis and fibrosis[J]. Int J Radiat Oncol Biol Phys,2006,65:1075-1086.
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