Inclusion of Incidental Radiation Dose to the Cardiac Atria and Ventricles Does Not Improve the Prediction of Radiation Pneumonitis in Advanced-Stage Non-Small Cell Lung Cancer Patients Treated With Intensity Modulated Radiation Therapy

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Title:	Inclusion of Incidental Radiation Dose to the Cardiac Atria and Ventricles Does Not Improve the Prediction of Radiation Pneumonitis in Advanced-Stage Non-Small Cell Lung Cancer Patients Treated With Intensity Modulated Radiation Therapy
Author(s):	Wijsman, R.; Dankers, F.J.W.M.; Troost, E.G.C. ; Hoffmann, A.L.; Heijden, E. van der ; Geus-Oei, L.F. de ; Bussink, J.
Publication year:	2017
Source:	International Journal of Radiation Oncology, Biology, Physics, vol. 99, iss. 2, (2017), pp. 434-441
ISSN:	0360-3016
DOI:	https://doi.org/10.1016/j.ijrobp.2017.04.011
Publication type:	Article / Letter to editor
Please use this identifier to cite or link to this item : https://hdl.handle.net/2066/177778
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Subject:	Radboudumc 17: Women's cancers RIHS: Radboud Institute for Health Sciences Radboudumc 9: Rare cancers RIHS: Radboud Institute for Health Sciences Tijdelijke code tbv inlezen publicaties Radboudumc - Alleen voor gebruik door Radboudumc
Organization:	Radiation Oncology Pulmonary Diseases Medical Imaging
Journal title:	International Journal of Radiation Oncology, Biology, Physics
Volume:	vol. 99
Issue:	iss. 2
Page start:	p. 434
Page end:	p. 441
Abstract:	PURPOSE: To evaluate whether inclusion of incidental radiation dose to the cardiac atria and ventricles improves the prediction of grade >/=3 radiation pneumonitis (RP) in advanced-stage non-small cell lung cancer (AS-NSCLC) patients treated with intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT). METHODS AND MATERIALS: Using a bootstrap modeling approach, clinical parameters and dose-volume histogram (DVH) parameters of lungs and heart (assessing atria and ventricles separately and combined) were evaluated for RP prediction in 188 AS-NSCLC patients. RESULTS: After a median follow-up of 18.4 months, 26 patients (13.8%) developed RP. Only the median mean lung dose (MLD) differed between groups (15.3 Gy vs 13.7 Gy for the RP and non-RP group, respectively; P=.004). The MLD showed the highest Spearman correlation coefficient (Rs) for RP (Rs = 0.21; P<.01). Most Rs of the lung DVH parameters exceeded those of the heart DVH parameters. After predictive modeling using a bootstrap procedure, the MLD was always included in the predictive model for grade >/=3 RP, whereas the heart DVH parameters were seldom included in the model. CONCLUSION: Incidental dose to the cardiac atria and ventricles did not improve RP risk prediction in our cohort of 188 AS-NSCLC patients treated with IMRT or VMAT.