Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies

Jing Zhao, Ellen D. Yorke, Ling Li, Brian D. Kavanagh, X. Allen Li, Shiva Das, Moyed Miften, Andreas Rimner, Jeffrey Campbell, Jinyu Xue, Andrew Jackson, Jimm Grimm, Michael T. Milano, Feng Ming Kong

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Abstract

Purpose To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiation therapy (SBRT) of the thorax. Methods and Materials Published studies on lung toxicity in patients with early-stage non–small cell lung cancer (NSCLC) or metastatic lung tumors treated with SBRT were pooled and analyzed. The primary endpoint was RILT, including pneumonitis and fibrosis. Data of RILT and risk factors were extracted from each study, and rates of grade 2 to 5 (G2+) and grade 3 to 5 (G3+) RILT were computed. Patient, tumor, and dosimetric factors were analyzed for their correlation with RILT. Results Eighty-eight studies (7752 patients) that reported RILT incidence were eligible. The pooled rates of G2+ and G3+ RILT from all 88 studies were 9.1% (95% confidence interval [CI]: 7.15-11.4) and 1.8% (95% CI: 1.3-2.5), respectively. The median of median tumor sizes was 2.3 (range, 1.4-4.1) cm. Among the factors analyzed, older patient age (P=.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ (P=.049) and G3+ RILT (P=.001). Patients with stage IA versus stage IB NSCLC had significantly lower risks of G2+ RILT (8.3% vs 17.1%, odds ratio = 0.43, 95% CI: 0.29-0.64, P<.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) (P=.027) and V20 (P=.019) in patients with G2+ RILT than in those with grade 0 to 1 RILT. Conclusions The overall rate of RILT is relatively low after thoracic SBRT. Older age and larger tumor size are significant adverse risk factors for RILT. Lung dosimetry, specifically lung V20 and MLD, also significantly affect RILT risk.

Original languageEnglish (US)
Pages (from-to)1357-1366
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume95
Issue number5
DOIs
StatePublished - Aug 1 2016

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thorax
toxicity
lungs
radiation therapy
Radiotherapy
Thorax
Radiation
Lung
radiation
tumors
confidence
grade
Confidence Intervals
Neoplasms
Non-Small Cell Lung Carcinoma
intervals
cancer

ASJC Scopus subject areas

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

Cite this

Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax : A Pooled Analysis of 88 Studies. / Zhao, Jing; Yorke, Ellen D.; Li, Ling; Kavanagh, Brian D.; Li, X. Allen; Das, Shiva; Miften, Moyed; Rimner, Andreas; Campbell, Jeffrey; Xue, Jinyu; Jackson, Andrew; Grimm, Jimm; Milano, Michael T.; Kong, Feng Ming.

In: International Journal of Radiation Oncology Biology Physics, Vol. 95, No. 5, 01.08.2016, p. 1357-1366.

Research output: Contribution to journalArticle

Zhao, J, Yorke, ED, Li, L, Kavanagh, BD, Li, XA, Das, S, Miften, M, Rimner, A, Campbell, J, Xue, J, Jackson, A, Grimm, J, Milano, MT & Kong, FM 2016, 'Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies', International Journal of Radiation Oncology Biology Physics, vol. 95, no. 5, pp. 1357-1366. https://doi.org/10.1016/j.ijrobp.2016.03.024
Zhao, Jing ; Yorke, Ellen D. ; Li, Ling ; Kavanagh, Brian D. ; Li, X. Allen ; Das, Shiva ; Miften, Moyed ; Rimner, Andreas ; Campbell, Jeffrey ; Xue, Jinyu ; Jackson, Andrew ; Grimm, Jimm ; Milano, Michael T. ; Kong, Feng Ming. / Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax : A Pooled Analysis of 88 Studies. In: International Journal of Radiation Oncology Biology Physics. 2016 ; Vol. 95, No. 5. pp. 1357-1366.
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abstract = "Purpose To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiation therapy (SBRT) of the thorax. Methods and Materials Published studies on lung toxicity in patients with early-stage non–small cell lung cancer (NSCLC) or metastatic lung tumors treated with SBRT were pooled and analyzed. The primary endpoint was RILT, including pneumonitis and fibrosis. Data of RILT and risk factors were extracted from each study, and rates of grade 2 to 5 (G2+) and grade 3 to 5 (G3+) RILT were computed. Patient, tumor, and dosimetric factors were analyzed for their correlation with RILT. Results Eighty-eight studies (7752 patients) that reported RILT incidence were eligible. The pooled rates of G2+ and G3+ RILT from all 88 studies were 9.1{\%} (95{\%} confidence interval [CI]: 7.15-11.4) and 1.8{\%} (95{\%} CI: 1.3-2.5), respectively. The median of median tumor sizes was 2.3 (range, 1.4-4.1) cm. Among the factors analyzed, older patient age (P=.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ (P=.049) and G3+ RILT (P=.001). Patients with stage IA versus stage IB NSCLC had significantly lower risks of G2+ RILT (8.3{\%} vs 17.1{\%}, odds ratio = 0.43, 95{\%} CI: 0.29-0.64, P<.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) (P=.027) and V20 (P=.019) in patients with G2+ RILT than in those with grade 0 to 1 RILT. Conclusions The overall rate of RILT is relatively low after thoracic SBRT. Older age and larger tumor size are significant adverse risk factors for RILT. Lung dosimetry, specifically lung V20 and MLD, also significantly affect RILT risk.",
author = "Jing Zhao and Yorke, {Ellen D.} and Ling Li and Kavanagh, {Brian D.} and Li, {X. Allen} and Shiva Das and Moyed Miften and Andreas Rimner and Jeffrey Campbell and Jinyu Xue and Andrew Jackson and Jimm Grimm and Milano, {Michael T.} and Kong, {Feng Ming}",
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T1 - Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax

T2 - A Pooled Analysis of 88 Studies

AU - Zhao, Jing

AU - Yorke, Ellen D.

AU - Li, Ling

AU - Kavanagh, Brian D.

AU - Li, X. Allen

AU - Das, Shiva

AU - Miften, Moyed

AU - Rimner, Andreas

AU - Campbell, Jeffrey

AU - Xue, Jinyu

AU - Jackson, Andrew

AU - Grimm, Jimm

AU - Milano, Michael T.

AU - Kong, Feng Ming

PY - 2016/8/1

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N2 - Purpose To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiation therapy (SBRT) of the thorax. Methods and Materials Published studies on lung toxicity in patients with early-stage non–small cell lung cancer (NSCLC) or metastatic lung tumors treated with SBRT were pooled and analyzed. The primary endpoint was RILT, including pneumonitis and fibrosis. Data of RILT and risk factors were extracted from each study, and rates of grade 2 to 5 (G2+) and grade 3 to 5 (G3+) RILT were computed. Patient, tumor, and dosimetric factors were analyzed for their correlation with RILT. Results Eighty-eight studies (7752 patients) that reported RILT incidence were eligible. The pooled rates of G2+ and G3+ RILT from all 88 studies were 9.1% (95% confidence interval [CI]: 7.15-11.4) and 1.8% (95% CI: 1.3-2.5), respectively. The median of median tumor sizes was 2.3 (range, 1.4-4.1) cm. Among the factors analyzed, older patient age (P=.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ (P=.049) and G3+ RILT (P=.001). Patients with stage IA versus stage IB NSCLC had significantly lower risks of G2+ RILT (8.3% vs 17.1%, odds ratio = 0.43, 95% CI: 0.29-0.64, P<.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) (P=.027) and V20 (P=.019) in patients with G2+ RILT than in those with grade 0 to 1 RILT. Conclusions The overall rate of RILT is relatively low after thoracic SBRT. Older age and larger tumor size are significant adverse risk factors for RILT. Lung dosimetry, specifically lung V20 and MLD, also significantly affect RILT risk.

AB - Purpose To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiation therapy (SBRT) of the thorax. Methods and Materials Published studies on lung toxicity in patients with early-stage non–small cell lung cancer (NSCLC) or metastatic lung tumors treated with SBRT were pooled and analyzed. The primary endpoint was RILT, including pneumonitis and fibrosis. Data of RILT and risk factors were extracted from each study, and rates of grade 2 to 5 (G2+) and grade 3 to 5 (G3+) RILT were computed. Patient, tumor, and dosimetric factors were analyzed for their correlation with RILT. Results Eighty-eight studies (7752 patients) that reported RILT incidence were eligible. The pooled rates of G2+ and G3+ RILT from all 88 studies were 9.1% (95% confidence interval [CI]: 7.15-11.4) and 1.8% (95% CI: 1.3-2.5), respectively. The median of median tumor sizes was 2.3 (range, 1.4-4.1) cm. Among the factors analyzed, older patient age (P=.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ (P=.049) and G3+ RILT (P=.001). Patients with stage IA versus stage IB NSCLC had significantly lower risks of G2+ RILT (8.3% vs 17.1%, odds ratio = 0.43, 95% CI: 0.29-0.64, P<.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) (P=.027) and V20 (P=.019) in patients with G2+ RILT than in those with grade 0 to 1 RILT. Conclusions The overall rate of RILT is relatively low after thoracic SBRT. Older age and larger tumor size are significant adverse risk factors for RILT. Lung dosimetry, specifically lung V20 and MLD, also significantly affect RILT risk.

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