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Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy
Published on: June 7, 2015
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Predictors of Chest Wall Toxicity after Lung Stereotactic Ablative Radiotherapy
I Thibault1, A Chiang1, D Erler1
1Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|July 2, 2015
Summary
Stereotactic ablative radiotherapy (SABR) for lung tumors can cause rib fractures, especially when tumors are near the chest wall. Osteoporosis increases fracture risk in these patients.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Lung stereotactic ablative radiotherapy (SABR) is an effective treatment for early-stage lung cancer.
- Chest wall toxicity, including rib fracture and pain, is a potential complication of lung SABR.
Purpose of the Study:
- To investigate the incidence of rib fractures and chest wall pain following lung SABR.
- To identify clinical and dosimetric predictors of these toxicities.
Main Methods:
- A retrospective review of 289 lung SABR treatments in 239 patients.
- Analysis of dose-volume histogram (DVH) metrics and clinical factors to predict toxicity.
Main Results:
- The incidence of rib fracture was 17%, with 44% being symptomatic.
- Tumor proximity to the chest wall (<5 mm) was the only independent predictor of rib fracture on multivariate analysis.
- Osteoporosis was a significant predictor of fracture in patients with tumors adjacent to the chest wall.
Conclusions:
- Chest wall DVH metrics do not independently predict SABR-induced rib fractures when tumor location is considered.
- Patients with lung tumors adjacent to the chest wall face a higher risk of rib fracture after SABR.
- Osteoporotic patients with chest wall-adjacent tumors have an increased risk of fracture.
