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A total EQD2 greater than 85 Gy for trachea and main bronchus D2cc being associated with severe late complications after definitive endobronchial brachytherapy.

Murakami N, Kobayashi K, Nakamura S, Wakita A, Okamoto H, Tsuchida K, Kashihara T, Harada K, Yamada M, Sekii S, Takahashi K, Umezawa R, Inaba K, Ito Y, Igaki H, Itami J - J Contemp Brachytherapy (2015)

Bottom Line: The mean EQD2 of LRT D2cc, TMB D2cc, D1cc, and D0.5cc of patients with or without late severe respiratory complications was significantly different between two groups (p = 0.018, 0.008, 0.009, and 0.013, respectively).The 2-year incidence rates of late severe complications in patients with TMB D2cc ≤ 85 Gy in EQD2 and > 85 Gy were 0% and 83.3%, respectively with a statistically significance (p = 0.014).It was discovered that TMB D2cc > 85 Gy in EQD2 is a strong risk factor for severe late respiratory complication after EBBT.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.

ABSTRACT

Purpose: The endobronchial brachytherapy (EBBT) is an established treatment method for tumors of the tracheobronchial system, however, little is known about the tolerance dose for organ at risk (OAR) in EBBT. The purpose of this study is to analyze patients with superficial bronchial carcinoma treated with definitive EBBT, and to investigate a relationship between late complications and dose for OAR.

Material and methods: Endobronchial brachytherapy was performed 6 Gy per fraction for three to four fractions with or without external beam radiation therapy (EBRT). For the purpose of dosimetric analysis, the wall of the lower respiratory tract (LRT: trachea, main bronchus, and lobar bronchiole), trachea, and main bronchus (TMB) was extracted. D0.5cc, D1cc, and D2cc of LRT and TMB were calculated in each EBBT session and added together. V100, V150, and V200 of LRT were also calculated.

Results: Between March 2008 and April 2014, EBBT was performed in 14 patients for curative intent. The 2-year overall survival (OS), progression-free survival (PFS), and local recurrence free survival (LRFS) was 82.1%, 77.9%, and 91.7%, respectively. There was one patient with grade 5, one grade 4, and three grade 3 obstruction of trachea or bronchus. The mean EQD2 of LRT D2cc, TMB D2cc, D1cc, and D0.5cc of patients with or without late severe respiratory complications was significantly different between two groups (p = 0.018, 0.008, 0.009, and 0.013, respectively). The 2-year incidence rates of late severe complications in patients with TMB D2cc ≤ 85 Gy in EQD2 and > 85 Gy were 0% and 83.3%, respectively with a statistically significance (p = 0.014).

Conclusions: It was discovered that TMB D2cc > 85 Gy in EQD2 is a strong risk factor for severe late respiratory complication after EBBT.

No MeSH data available.


Related in: MedlinePlus

Cumulative incidence of grade 3 or greater late respiratory complication stratified by trachea and main bronchus (TMB) D2cc 85 Gy in EQD2
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Figure 0003: Cumulative incidence of grade 3 or greater late respiratory complication stratified by trachea and main bronchus (TMB) D2cc 85 Gy in EQD2

Mentions: For the analysis of the dose tolerance of OAR, patient with local recurrence was excluded because it was difficult to distinguish the complications whether to be caused by EBBT or by tumor progression; therefore, 13 patients entered the analysis. There was one patient with grade 5, one grade 4, and three grade 3 obstruction of trachea or bronchus. Patient with grade 4 trachea obstruction developed severe aspiration pneumonia 22.6 months after EBBT. This patient received antibiotics and underwent tracheotomy, which made it easier to aspire infective sputum and eventually pneumonia resolved. Median time of development of late severe respiratory complications was 15.3 months (10.6-22.6). Comparison of dose-volume parameters of the LRT and TMB was summarized in Table 4 for the patients with or without late severe respiratory complications. The mean EQD2 of LRT D2cc, TMB D2cc, D1cc, and D0.5cc of patients with or without late severe respiratory complications was significantly different between two groups (p = 0.018, 0.008, 0.009, and 0.013, respectively). Patients with late severe respiratory complications showed a trend toward having larger LRT V100 and V150 (p = 0.06 and 0.051). The 2-year incidence rates of late severe respiratory complications in patients with TMB D2cc equal to or less than 85 Gy in EQD2, and over 85 Gy were 0% and 83.3%, respectively with a statistically significant difference (Figure 3, p = 0.014).


A total EQD2 greater than 85 Gy for trachea and main bronchus D2cc being associated with severe late complications after definitive endobronchial brachytherapy.

Murakami N, Kobayashi K, Nakamura S, Wakita A, Okamoto H, Tsuchida K, Kashihara T, Harada K, Yamada M, Sekii S, Takahashi K, Umezawa R, Inaba K, Ito Y, Igaki H, Itami J - J Contemp Brachytherapy (2015)

Cumulative incidence of grade 3 or greater late respiratory complication stratified by trachea and main bronchus (TMB) D2cc 85 Gy in EQD2
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663210&req=5

Figure 0003: Cumulative incidence of grade 3 or greater late respiratory complication stratified by trachea and main bronchus (TMB) D2cc 85 Gy in EQD2
Mentions: For the analysis of the dose tolerance of OAR, patient with local recurrence was excluded because it was difficult to distinguish the complications whether to be caused by EBBT or by tumor progression; therefore, 13 patients entered the analysis. There was one patient with grade 5, one grade 4, and three grade 3 obstruction of trachea or bronchus. Patient with grade 4 trachea obstruction developed severe aspiration pneumonia 22.6 months after EBBT. This patient received antibiotics and underwent tracheotomy, which made it easier to aspire infective sputum and eventually pneumonia resolved. Median time of development of late severe respiratory complications was 15.3 months (10.6-22.6). Comparison of dose-volume parameters of the LRT and TMB was summarized in Table 4 for the patients with or without late severe respiratory complications. The mean EQD2 of LRT D2cc, TMB D2cc, D1cc, and D0.5cc of patients with or without late severe respiratory complications was significantly different between two groups (p = 0.018, 0.008, 0.009, and 0.013, respectively). Patients with late severe respiratory complications showed a trend toward having larger LRT V100 and V150 (p = 0.06 and 0.051). The 2-year incidence rates of late severe respiratory complications in patients with TMB D2cc equal to or less than 85 Gy in EQD2, and over 85 Gy were 0% and 83.3%, respectively with a statistically significant difference (Figure 3, p = 0.014).

Bottom Line: The mean EQD2 of LRT D2cc, TMB D2cc, D1cc, and D0.5cc of patients with or without late severe respiratory complications was significantly different between two groups (p = 0.018, 0.008, 0.009, and 0.013, respectively).The 2-year incidence rates of late severe complications in patients with TMB D2cc ≤ 85 Gy in EQD2 and > 85 Gy were 0% and 83.3%, respectively with a statistically significance (p = 0.014).It was discovered that TMB D2cc > 85 Gy in EQD2 is a strong risk factor for severe late respiratory complication after EBBT.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.

ABSTRACT

Purpose: The endobronchial brachytherapy (EBBT) is an established treatment method for tumors of the tracheobronchial system, however, little is known about the tolerance dose for organ at risk (OAR) in EBBT. The purpose of this study is to analyze patients with superficial bronchial carcinoma treated with definitive EBBT, and to investigate a relationship between late complications and dose for OAR.

Material and methods: Endobronchial brachytherapy was performed 6 Gy per fraction for three to four fractions with or without external beam radiation therapy (EBRT). For the purpose of dosimetric analysis, the wall of the lower respiratory tract (LRT: trachea, main bronchus, and lobar bronchiole), trachea, and main bronchus (TMB) was extracted. D0.5cc, D1cc, and D2cc of LRT and TMB were calculated in each EBBT session and added together. V100, V150, and V200 of LRT were also calculated.

Results: Between March 2008 and April 2014, EBBT was performed in 14 patients for curative intent. The 2-year overall survival (OS), progression-free survival (PFS), and local recurrence free survival (LRFS) was 82.1%, 77.9%, and 91.7%, respectively. There was one patient with grade 5, one grade 4, and three grade 3 obstruction of trachea or bronchus. The mean EQD2 of LRT D2cc, TMB D2cc, D1cc, and D0.5cc of patients with or without late severe respiratory complications was significantly different between two groups (p = 0.018, 0.008, 0.009, and 0.013, respectively). The 2-year incidence rates of late severe complications in patients with TMB D2cc ≤ 85 Gy in EQD2 and > 85 Gy were 0% and 83.3%, respectively with a statistically significance (p = 0.014).

Conclusions: It was discovered that TMB D2cc > 85 Gy in EQD2 is a strong risk factor for severe late respiratory complication after EBBT.

No MeSH data available.


Related in: MedlinePlus