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Meta-analysis of incidence of early lung toxicity in 3-dimensional conformal irradiation of breast carcinomas.

Gokula K, Earnest A, Wong LC - Radiat Oncol (2013)

Bottom Line: A poorly powered study in IMN group contributed to the negative finding.Smoking has a trend towards protective effect against RP.Use of other modalities may be considered when Ipsilateral lung V20Gy > 30% or MLD > 15 Gy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia. gokudroid@gmail.com.

ABSTRACT

Background: This meta-analysis aims to ascertain the significance of early lung toxicity with 3-Dimensional (3D) conformal irradiation for breast carcinomas and identify the sub-groups of patients with increased risk.

Methods: Electronic databases, reference sections of major oncological textbooks and identified studies were searched for synonyms of breast radiotherapy and radiation pneumonitis (RP). Major studies in thoracic irradiation were reviewed to identify factors frequently associated with RP. Meta-analysis for RP incidence estimation and odds ratio calculation were carried out.

Results: The overall incidence of Clinical and Radiological RP is 14% and 42% respectively. Ten studies were identified. Dose-volume Histogram (DVH) related dosimetric factors (Volume of lung receiving certain dose, Vdose and Mean lung Dose, MLD), supraclavicular fossa (SCF) irradiation and age are significantly associated with RP, but not sequential chemotherapy and concomitant use of Tamoxifen. A poorly powered study in IMN group contributed to the negative finding. Smoking has a trend towards protective effect against RP.

Conclusion: Use of other modalities may be considered when Ipsilateral lung V20Gy > 30% or MLD > 15 Gy. Extra caution is needed in SCF and IMN irradiation as they are likely to influence these dosimetric parameters.

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Meta-analysis: Incidence of radiological RP with 3D-CRT for BC in world literature.
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Figure 1: Meta-analysis: Incidence of radiological RP with 3D-CRT for BC in world literature.

Mentions: The overall incidence of radiological RP in our meta-analysis [Figure 1] is 42% (95% CI = 22-62%) with large heterogeneity in the included studies (I-squared = 97.4%, p < 0.001) and Egger’s test did not show significant publication bias (p = 0.151). In the study by Marco Krengli et al.[23], the high detection rate of RP (85%) could be attributed to the use of high resolution CT images for post radiotherapy lung assessment. The incidence of RP was low, as reported by Akiko Kubo et al.[24] because only tangential RT fields were used and the RP assessment was mainly done by Chest X-ray (CXR).


Meta-analysis of incidence of early lung toxicity in 3-dimensional conformal irradiation of breast carcinomas.

Gokula K, Earnest A, Wong LC - Radiat Oncol (2013)

Meta-analysis: Incidence of radiological RP with 3D-CRT for BC in world literature.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3842634&req=5

Figure 1: Meta-analysis: Incidence of radiological RP with 3D-CRT for BC in world literature.
Mentions: The overall incidence of radiological RP in our meta-analysis [Figure 1] is 42% (95% CI = 22-62%) with large heterogeneity in the included studies (I-squared = 97.4%, p < 0.001) and Egger’s test did not show significant publication bias (p = 0.151). In the study by Marco Krengli et al.[23], the high detection rate of RP (85%) could be attributed to the use of high resolution CT images for post radiotherapy lung assessment. The incidence of RP was low, as reported by Akiko Kubo et al.[24] because only tangential RT fields were used and the RP assessment was mainly done by Chest X-ray (CXR).

Bottom Line: A poorly powered study in IMN group contributed to the negative finding.Smoking has a trend towards protective effect against RP.Use of other modalities may be considered when Ipsilateral lung V20Gy > 30% or MLD > 15 Gy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia. gokudroid@gmail.com.

ABSTRACT

Background: This meta-analysis aims to ascertain the significance of early lung toxicity with 3-Dimensional (3D) conformal irradiation for breast carcinomas and identify the sub-groups of patients with increased risk.

Methods: Electronic databases, reference sections of major oncological textbooks and identified studies were searched for synonyms of breast radiotherapy and radiation pneumonitis (RP). Major studies in thoracic irradiation were reviewed to identify factors frequently associated with RP. Meta-analysis for RP incidence estimation and odds ratio calculation were carried out.

Results: The overall incidence of Clinical and Radiological RP is 14% and 42% respectively. Ten studies were identified. Dose-volume Histogram (DVH) related dosimetric factors (Volume of lung receiving certain dose, Vdose and Mean lung Dose, MLD), supraclavicular fossa (SCF) irradiation and age are significantly associated with RP, but not sequential chemotherapy and concomitant use of Tamoxifen. A poorly powered study in IMN group contributed to the negative finding. Smoking has a trend towards protective effect against RP.

Conclusion: Use of other modalities may be considered when Ipsilateral lung V20Gy > 30% or MLD > 15 Gy. Extra caution is needed in SCF and IMN irradiation as they are likely to influence these dosimetric parameters.

Show MeSH
Related in: MedlinePlus