Effect of normal lung definition on lung dosimetry and lung toxicity prediction in radiation therapy treatment planning

Weili Wang, Yaping Xu, Matthew Schipper, Martha M. Matuszak, Timothy Ritter, Yue Cao, Randall K. Ten Haken, Feng Ming Kong

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: This study aimed to compare lung dose-volume histogram (DVH) parameters such as mean lung dose (MLD) and the lung volume receiving ≥20 Gy (V20) of commonly used definitions of normal lung in terms of tumor/target subtraction and to determine to what extent they differ in predicting radiation pneumonitis (RP). Methods and Materials: One hundred lung cancer patients treated with definitive radiation therapy were assessed. The gross tumor volume (GTV) and clinical planning target volume (PTVc) were defined by the treating physician and dosimetrist. For this study, the clinical target volume (CTV) was defined as GTV with 8-mm uniform expansion, and the PTV was defined as CTV with an 8-mm uniform expansion. Lung DVHs were generated with exclusion of targets: (1) GTV (DVHG); (2) CTV (DVHC); (3) PTV (DVH P); and (4) PTVc (DVHPc). The lung DVHs, V20s, and MLDs from each of the 4 methods were compared, as was their significance in predicting radiation pneumonitis of grade 2 or greater (RP2). Results: There are significant differences in dosimetric parameters among the various definition methods (all Ps<.05). The mean and maximum differences in V20 are 4.4% and 12.6% (95% confidence interval 3.6%-5.1%), respectively. The mean and maximum differences in MLD are 3.3 Gy and 7.5 Gy (95% confidence interval, 1.7-4.8 Gy), respectively. MLDs of all methods are highly correlated with each other and significantly correlated with clinical RP2, although V20s are not. For RP2 prediction, on the receiver operating characteristic curve, MLD from DVH G (MLDG) has a greater area under curve of than MLD from DVHC (MLDC) or DVHP (MLDP). Limiting RP2 to 30%, the threshold is 22.4, 20.6, and 18.8 Gy, for MLDG, MLDC, and MLDP, respectively. Conclusions: The differences in MLD and V20 from various lung definitions are significant. MLD from the GTV exclusion method may be more accurate in predicting clinical significant radiation pneumonitis.

Original languageEnglish (US)
Pages (from-to)956-963
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume86
Issue number5
DOIs
StatePublished - Aug 1 2013

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toxicity
lungs
dosimeters
planning
radiation therapy
Radiotherapy
Lung
predictions
dosage
Radiation Pneumonitis
Tumor Burden
tumors
Therapeutics
histograms
exclusion
confidence
radiation
Confidence Intervals
intervals
expansion

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Effect of normal lung definition on lung dosimetry and lung toxicity prediction in radiation therapy treatment planning. / Wang, Weili; Xu, Yaping; Schipper, Matthew; Matuszak, Martha M.; Ritter, Timothy; Cao, Yue; Ten Haken, Randall K.; Kong, Feng Ming.

In: International Journal of Radiation Oncology Biology Physics, Vol. 86, No. 5, 01.08.2013, p. 956-963.

Research output: Contribution to journalArticle

Wang, Weili ; Xu, Yaping ; Schipper, Matthew ; Matuszak, Martha M. ; Ritter, Timothy ; Cao, Yue ; Ten Haken, Randall K. ; Kong, Feng Ming. / Effect of normal lung definition on lung dosimetry and lung toxicity prediction in radiation therapy treatment planning. In: International Journal of Radiation Oncology Biology Physics. 2013 ; Vol. 86, No. 5. pp. 956-963.
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abstract = "Purpose: This study aimed to compare lung dose-volume histogram (DVH) parameters such as mean lung dose (MLD) and the lung volume receiving ≥20 Gy (V20) of commonly used definitions of normal lung in terms of tumor/target subtraction and to determine to what extent they differ in predicting radiation pneumonitis (RP). Methods and Materials: One hundred lung cancer patients treated with definitive radiation therapy were assessed. The gross tumor volume (GTV) and clinical planning target volume (PTVc) were defined by the treating physician and dosimetrist. For this study, the clinical target volume (CTV) was defined as GTV with 8-mm uniform expansion, and the PTV was defined as CTV with an 8-mm uniform expansion. Lung DVHs were generated with exclusion of targets: (1) GTV (DVHG); (2) CTV (DVHC); (3) PTV (DVH P); and (4) PTVc (DVHPc). The lung DVHs, V20s, and MLDs from each of the 4 methods were compared, as was their significance in predicting radiation pneumonitis of grade 2 or greater (RP2). Results: There are significant differences in dosimetric parameters among the various definition methods (all Ps<.05). The mean and maximum differences in V20 are 4.4{\%} and 12.6{\%} (95{\%} confidence interval 3.6{\%}-5.1{\%}), respectively. The mean and maximum differences in MLD are 3.3 Gy and 7.5 Gy (95{\%} confidence interval, 1.7-4.8 Gy), respectively. MLDs of all methods are highly correlated with each other and significantly correlated with clinical RP2, although V20s are not. For RP2 prediction, on the receiver operating characteristic curve, MLD from DVH G (MLDG) has a greater area under curve of than MLD from DVHC (MLDC) or DVHP (MLDP). Limiting RP2 to 30{\%}, the threshold is 22.4, 20.6, and 18.8 Gy, for MLDG, MLDC, and MLDP, respectively. Conclusions: The differences in MLD and V20 from various lung definitions are significant. MLD from the GTV exclusion method may be more accurate in predicting clinical significant radiation pneumonitis.",
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AU - Xu, Yaping

AU - Schipper, Matthew

AU - Matuszak, Martha M.

AU - Ritter, Timothy

AU - Cao, Yue

AU - Ten Haken, Randall K.

AU - Kong, Feng Ming

PY - 2013/8/1

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N2 - Purpose: This study aimed to compare lung dose-volume histogram (DVH) parameters such as mean lung dose (MLD) and the lung volume receiving ≥20 Gy (V20) of commonly used definitions of normal lung in terms of tumor/target subtraction and to determine to what extent they differ in predicting radiation pneumonitis (RP). Methods and Materials: One hundred lung cancer patients treated with definitive radiation therapy were assessed. The gross tumor volume (GTV) and clinical planning target volume (PTVc) were defined by the treating physician and dosimetrist. For this study, the clinical target volume (CTV) was defined as GTV with 8-mm uniform expansion, and the PTV was defined as CTV with an 8-mm uniform expansion. Lung DVHs were generated with exclusion of targets: (1) GTV (DVHG); (2) CTV (DVHC); (3) PTV (DVH P); and (4) PTVc (DVHPc). The lung DVHs, V20s, and MLDs from each of the 4 methods were compared, as was their significance in predicting radiation pneumonitis of grade 2 or greater (RP2). Results: There are significant differences in dosimetric parameters among the various definition methods (all Ps<.05). The mean and maximum differences in V20 are 4.4% and 12.6% (95% confidence interval 3.6%-5.1%), respectively. The mean and maximum differences in MLD are 3.3 Gy and 7.5 Gy (95% confidence interval, 1.7-4.8 Gy), respectively. MLDs of all methods are highly correlated with each other and significantly correlated with clinical RP2, although V20s are not. For RP2 prediction, on the receiver operating characteristic curve, MLD from DVH G (MLDG) has a greater area under curve of than MLD from DVHC (MLDC) or DVHP (MLDP). Limiting RP2 to 30%, the threshold is 22.4, 20.6, and 18.8 Gy, for MLDG, MLDC, and MLDP, respectively. Conclusions: The differences in MLD and V20 from various lung definitions are significant. MLD from the GTV exclusion method may be more accurate in predicting clinical significant radiation pneumonitis.

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