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- W2012911554 abstract "Stereotactic ablative body radiotherapy (SABR) achieves high local control rates in peripheral Stage I non-small cell lung cancer (NSCLC). Severe toxicity is uncommon but few reports have included large patient numbers with long follow-up. We studied risk factors and dosimetric parameters for chest wall pain (CWP) and rib fractures in patients treated at a single center. Between 2003 and 2009, 500 patients underwent SABR for T1N0 or T2N0 NSCLC using a risk-adapted scheme consisting of 3 fractions of 20 Gy (T1 lesions), 5 x 12 Gy (T1 showing broad contact with chest wall or T2) or 8 x 7.5 Gy (central lesions). Target volumes (PTV) were derived using a 3-mm margin added to tumor positions on 4D-CT scans (ITV). Biologically equivalent dose (BED) to chest wall was calculated using the linear quadratic model with 3 x 20 Gy as reference. The chest wall was defined as an expansion of the 2 cm of the lungs (Kong, 2010). Chest wall receiving 30, 40, 45, and 50 Gy (V30 Gy, V40 Gy, V45 Gy, and V50 Gy) and maximum dose in 2 cm3 of chest wall (D2 cc) were recorded. Characteristics studied were gender, age, comorbidity, number of fractions, PTV volume, and tumor-to-CW distance. Median follow-up was 33 months. Overall survival and local control rates at 3 years were 53.1% and 90.4%. Chest wall pain (any grade), severe CWP (Grade 3) and rib fractures were observed in 11.4%, 2.0%, and 1.6%, respectively. Seven of 8 patients with rib fractures experienced pain. Multivariate analysis showed CWP and/or rib fractures to be related to larger PTV volumes (p = 0.025) and smaller tumor-CW-distances (p = 0.038) compared to asymptomatic patients. Fractionation scheme did not independently predict chest toxicity. Dosimetric results (Table) revealed a trend linking severe CWP and rib fractures with higher chest wall volumes irradiated to all dose levels. A larger PTV volume and a smaller distance to the chest wall are predictive factors for the development of chest wall toxicity after thoracic SABR. The dosimetric data support a gradually increasing dose-volume effect, rather than a specific threshold dose or volume. For rib fractures, the maximum dose may be relevant." @default.
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- W2012911554 date "2011-10-01" @default.
- W2012911554 modified "2023-09-27" @default.
- W2012911554 title "Predictors of Chest Wall Toxicity Following Risk-adapted Stereotactic Radiotherapy in 500 Patients Treated for Early Stage Lung Cancer" @default.
- W2012911554 doi "https://doi.org/10.1016/j.ijrobp.2011.06.1661" @default.
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