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Developing Multivariable Normal Tissue Complication Probability Model to Predict the Incidence of Symptomatic Radiation Pneumonitis among Breast Cancer Patients.

Lee TF, Chao PJ, Chang L, Ting HM, Huang YJ - PLoS ONE (2015)

Bottom Line: The final endpoint for acute SRP was defined as those who had density changes together with symptoms, as measured using computed tomography.Positive associations were demonstrated among the incidence of SRP, IV20, and patient age.Energy, BMI and T stage showed a negative association with the incidence of SRP.

View Article: PubMed Central - PubMed

Affiliation: Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung 80778, Taiwan, ROC; Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, ROC.

ABSTRACT

Purpose: Symptomatic radiation pneumonitis (SRP), which decreases quality of life (QoL), is the most common pulmonary complication in patients receiving breast irradiation. If it occurs, acute SRP usually develops 4-12 weeks after completion of radiotherapy and presents as a dry cough, dyspnea and low-grade fever. If the incidence of SRP is reduced, not only the QoL but also the compliance of breast cancer patients may be improved. Therefore, we investigated the incidence SRP in breast cancer patients after hybrid intensity modulated radiotherapy (IMRT) to find the risk factors, which may have important effects on the risk of radiation-induced complications.

Methods: In total, 93 patients with breast cancer were evaluated. The final endpoint for acute SRP was defined as those who had density changes together with symptoms, as measured using computed tomography. The risk factors for a multivariate normal tissue complication probability model of SRP were determined using the least absolute shrinkage and selection operator (LASSO) technique.

Results: Five risk factors were selected using LASSO: the percentage of the ipsilateral lung volume that received more than 20-Gy (IV20), energy, age, body mass index (BMI) and T stage. Positive associations were demonstrated among the incidence of SRP, IV20, and patient age. Energy, BMI and T stage showed a negative association with the incidence of SRP. Our analyses indicate that the risk of SPR following hybrid IMRT in elderly or low-BMI breast cancer patients is increased once the percentage of the ipsilateral lung volume receiving more than 20-Gy is controlled below a limitation.

Conclusions: We suggest to define a dose-volume percentage constraint of IV20< 37% (or AIV20< 310cc) for the irradiated ipsilateral lung in radiation therapy treatment planning to maintain the incidence of SPR below 20%, and pay attention to the sequelae especially in elderly or low-BMI breast cancer patients. (AIV20: the absolute ipsilateral lung volume that received more than 20 Gy (cc).

No MeSH data available.


Related in: MedlinePlus

The univariate logistic normal tissue complication probability models with (a) IV20 and (b) AIV20 for symptomatic radiation pneumonitis in breast cancer patients treated with hybrid IMRT.Abbreviation: IV20: ipsilateral lung volume received >20Gy (%); AIV20: absolute ipsilateral lung volume received >20Gy (cc); IMRT: intensity modulated radiotherapy.
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pone.0131736.g003: The univariate logistic normal tissue complication probability models with (a) IV20 and (b) AIV20 for symptomatic radiation pneumonitis in breast cancer patients treated with hybrid IMRT.Abbreviation: IV20: ipsilateral lung volume received >20Gy (%); AIV20: absolute ipsilateral lung volume received >20Gy (cc); IMRT: intensity modulated radiotherapy.

Mentions: The univariate dose-response fitted curve (using IV20 and AIV20) for the incidence of SRP in breast cancer patients treated with hybrid IMRT is shown in Fig 3A and 3B. The parameters for the univariate NTCP regression analysis shown in Fig 3 were calculated using the percentage and the absolute of the ipsilateral lung volume that received more than 20 Gy (IV20 and AIV20). According to the NTCP curve, we determined the tolerances of IV20 and AIV20 producing a 50% complication rate (TV50) to be 46.7% and 660cc in breast cancer patients treated with hybrid IMRT, respectively. The tolerances IV20 and AIV20 corresponding to a 20% incidence of complications (TV20) was ≈ 37% and 310cc, respectively.


Developing Multivariable Normal Tissue Complication Probability Model to Predict the Incidence of Symptomatic Radiation Pneumonitis among Breast Cancer Patients.

Lee TF, Chao PJ, Chang L, Ting HM, Huang YJ - PLoS ONE (2015)

The univariate logistic normal tissue complication probability models with (a) IV20 and (b) AIV20 for symptomatic radiation pneumonitis in breast cancer patients treated with hybrid IMRT.Abbreviation: IV20: ipsilateral lung volume received >20Gy (%); AIV20: absolute ipsilateral lung volume received >20Gy (cc); IMRT: intensity modulated radiotherapy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492617&req=5

pone.0131736.g003: The univariate logistic normal tissue complication probability models with (a) IV20 and (b) AIV20 for symptomatic radiation pneumonitis in breast cancer patients treated with hybrid IMRT.Abbreviation: IV20: ipsilateral lung volume received >20Gy (%); AIV20: absolute ipsilateral lung volume received >20Gy (cc); IMRT: intensity modulated radiotherapy.
Mentions: The univariate dose-response fitted curve (using IV20 and AIV20) for the incidence of SRP in breast cancer patients treated with hybrid IMRT is shown in Fig 3A and 3B. The parameters for the univariate NTCP regression analysis shown in Fig 3 were calculated using the percentage and the absolute of the ipsilateral lung volume that received more than 20 Gy (IV20 and AIV20). According to the NTCP curve, we determined the tolerances of IV20 and AIV20 producing a 50% complication rate (TV50) to be 46.7% and 660cc in breast cancer patients treated with hybrid IMRT, respectively. The tolerances IV20 and AIV20 corresponding to a 20% incidence of complications (TV20) was ≈ 37% and 310cc, respectively.

Bottom Line: The final endpoint for acute SRP was defined as those who had density changes together with symptoms, as measured using computed tomography.Positive associations were demonstrated among the incidence of SRP, IV20, and patient age.Energy, BMI and T stage showed a negative association with the incidence of SRP.

View Article: PubMed Central - PubMed

Affiliation: Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung 80778, Taiwan, ROC; Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, ROC.

ABSTRACT

Purpose: Symptomatic radiation pneumonitis (SRP), which decreases quality of life (QoL), is the most common pulmonary complication in patients receiving breast irradiation. If it occurs, acute SRP usually develops 4-12 weeks after completion of radiotherapy and presents as a dry cough, dyspnea and low-grade fever. If the incidence of SRP is reduced, not only the QoL but also the compliance of breast cancer patients may be improved. Therefore, we investigated the incidence SRP in breast cancer patients after hybrid intensity modulated radiotherapy (IMRT) to find the risk factors, which may have important effects on the risk of radiation-induced complications.

Methods: In total, 93 patients with breast cancer were evaluated. The final endpoint for acute SRP was defined as those who had density changes together with symptoms, as measured using computed tomography. The risk factors for a multivariate normal tissue complication probability model of SRP were determined using the least absolute shrinkage and selection operator (LASSO) technique.

Results: Five risk factors were selected using LASSO: the percentage of the ipsilateral lung volume that received more than 20-Gy (IV20), energy, age, body mass index (BMI) and T stage. Positive associations were demonstrated among the incidence of SRP, IV20, and patient age. Energy, BMI and T stage showed a negative association with the incidence of SRP. Our analyses indicate that the risk of SPR following hybrid IMRT in elderly or low-BMI breast cancer patients is increased once the percentage of the ipsilateral lung volume receiving more than 20-Gy is controlled below a limitation.

Conclusions: We suggest to define a dose-volume percentage constraint of IV20< 37% (or AIV20< 310cc) for the irradiated ipsilateral lung in radiation therapy treatment planning to maintain the incidence of SPR below 20%, and pay attention to the sequelae especially in elderly or low-BMI breast cancer patients. (AIV20: the absolute ipsilateral lung volume that received more than 20 Gy (cc).

No MeSH data available.


Related in: MedlinePlus