Back
 IJMPCERO  Vol.7 No.1 , February 2018
Comparison of Stereotactic Body Radiotherapy Delivery Techniques for Early-Stage Lung Cancer Using Lung Toxicity Modeling
Abstract: Purpose: Lung toxicity is a primary side effect in stereotactic radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). We aimed to use a set of radiobiological models to evaluate and compare modern IMRT delivery techniques with three-dimensional conformal techniques for SBRT treatment of NSCLC in terms of lung toxicity, and aimed to compare the results from different radiobiologcal models. Methods: Ten early-stage NSCLC patients treated with SBRT were retrospectively selected. Five treatment plans were generated to deliver 50 Gy in five fractions to the planning target volume for each case: a helical tomotherapy (HT) plan, two three-dimensional cofnromal radiotherapy (3D-CRT) plans using 6-MV and 10-MV photon beams respectively, and two volumetric modulated arc therapy (VMAT) plans using one and two arc fields respectively. The lung RDV was calculated with three parallel functional sub-unit (FSU) models and two normal tissue complication probability (NTCP) models. Results: Both the HT and VMAT plans showed significantly higher contralateral mean lung dose and lower ipsilateral mean lung dose compared to the 3D-CRT plans. There was no statistically significant difference in terms of lung toxicities between the IMRT and 3D-CRT techniques using either the FSU models or the NTCP models. Based on both the FSU and the NTCP models, there was strong correlation between lung toxicity and the mean lung dose in SBRT treatment plans. Conclusions: Based on both the NTCP and parallel FSU models, both IMRT and traditional 3D-CRT delivery techniques could achieve comparable lung sparing inn SBRT treatment of early-stage lung cancer. However, the validity of the radiobiological model results should be checked by clinical data.
Cite this paper: Han, C. , Schultheiss, T. and Wong, J. (2018) Comparison of Stereotactic Body Radiotherapy Delivery Techniques for Early-Stage Lung Cancer Using Lung Toxicity Modeling. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 7, 1-14. doi: 10.4236/ijmpcero.2018.71001.
References

[1]   Chang, B.K. and Timmerman, R.D. (2007) Stereotactic Body Radiation Therapy: A Comprehensive Review. American Journal of Clinical Oncology, 30, 637-644.
https://doi.org/10.1097/COC.0b013e3180ca7cb1

[2]   Timmerman, R., Paulus, R., Galvin, J., et al. (2010) Stereotactic Body Radiation Therapy for Inoperable Early Stage Lung Cancer. JAMA, 303, 1070-1076.
https://doi.org/10.1001/jama.2010.261

[3]   Baker, S., Dahele, M., Lagerwaard, F.J. and Senan, S. (2016) A Critical Review of Recent Developments in Radiotherapy for Non-Small Cell Lung Cancer. Radiation Oncology, 11, 115.
https://doi.org/10.1186/s13014-016-0693-8

[4]   Chi, A., Liao, Z., Nguyen, N.P., et al. (2010) Systematic Review of the Patterns of Failure Following Stereotactic Body Radiation Therapy in Early-Stage Non-Small-Cell Lung Cancer: Clinical Implications. Radiotherapy and Oncology, 94, 1-11.
https://doi.org/10.1016/j.radonc.2009.12.008

[5]   Marks, L.B., Bentzen, S.M., Deasy, J.O., et al. (2010) Radiation Dose-Volume Effects in the Lung. International Journal of Radiation Oncology * Biology * Physics, 76, S70-S76.
https://doi.org/10.1016/j.ijrobp.2009.06.091

[6]   Jin, J., Kong, F., Chetty, I.J., et al. (2010) Impact of Fraction Size on Lung Radiation Toxicity: Hypofractionation May Be Beneficial in Dose Escalation of Radiotherapy for Lung Cancers. International Journal of Radiation Oncology * Biology * Physics, 76, 782-788.
https://doi.org/10.1016/j.ijrobp.2009.02.079

[7]   Niemierko, A. (1997) Reporting and Analyzing Dose Distributions: A Concept of Equivalent Uniform Dose. Medical Physics, 24, 103-110.
https://doi.org/10.1118/1.598063

[8]   Jackson, A., Kutcher, G.J., Yorke, E.D., et al. (1993) Probability of Radiation-Induced Complications for Normal Tissue with Parallel Architecture Subject to Non-Uniform Irradiation. Medical Physics, 20, 613-625.
https://doi.org/10.1118/1.597056

[9]   Yorke, E.D., Kutcher, G.J., Jackson, A. and Ling, C.C. (1993) Probability of Radiation-Induced Complications in Normal Tissues with Parallel Architecture under Conditions of Uniform Whole or Partial Organ Irradiation. Radiotherapy and Oncology, 26, 226-237.
https://doi.org/10.1016/0167-8140(93)90264-9

[10]   Jackson, A., Ten Haken, R.K., Robertson, J.M., et al. (1995) Analysis of Clinical Complication Data for Radiation Hepatitis Using a Parallel Architecture Model. International Journal of Radiation Oncology * Biology * Physics, 31, 883-891.
https://doi.org/10.1016/0360-3016(94)00471-4

[11]   Kwa, S.L.S., Theuws, J.C.T., Wagenaar, A., et al. (1998) Evaluation of Two Dose-Volume Histogram Reduction Models for the Prediction of Radiation Pneumonitis. Radiotherapy and Oncology, 48, 61-69.
https://doi.org/10.1016/S0167-8140(98)00020-6

[12]   Scheenstra, A.E.H., Rossi, M.M.G., Belderbos, J.S.A., et al. (2013) Local Dose-Effect Relations for Lung Perfusion Post Stereotactic Body Radiotherapy. Radiotherapy and Oncology, 107, 398-402.
https://doi.org/10.1016/j.radonc.2013.04.003

[13]   Guckenberger, M., Baier, K., Polat, B., et al. (2010) Dose-Response Relationship for Radiation-Induced Pneumonitis after Pulmonary Stereotactic Body Radiotherapy. Radiotherapy and Oncology, 97, 65-70.
https://doi.org/10.1016/j.radonc.2010.04.027

[14]   R Core Team (2013) R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna.
http://www.R-project.org/

[15]   Yamashita, H., Takahashi, W. and Haga, A. and Nakagawa, K. (2014) Radiation Pneumonitis after Stereotactic Radiation Therapy for Lung Cancer. World Journal of Radiology, 6, 708-715.
https://doi.org/10.4329/wjr.v6.i9.708

[16]   Ong, C.L., Verbakel, W.F.A.R., Cuijpers. J.P., et al. (2010) Stereotactic Radiotherapy for Peripheral Lung Tumors: A Comparison of Volumetric Modulated Arc Therapy with 3 Other Delivery Techniques. Radiotherapy and Oncology, 97, 437-442.
https://doi.org/10.1016/j.radonc.2010.09.027

[17]   McGrath, S.D., Matuszak, M.M., Yan, D., et al. (2010) Volumetric Modulated Arc Therapy for Delivery of Hypofractionated Stereotactic Lung Radiotherapy: A Dosimetric and Treatment Efficiency Analysis. Radiotherapy and Oncology, 95, 153-157.
https://doi.org/10.1016/j.radonc.2009.12.039

[18]   Jo, I., Kay, C., Kim, J., et al. (2010) Significance of Low-Dose Radiation Distribution in Development of Radiation Pneumonitis after Helical-Tomotherapy-Based Hypofractionated Radiotherapy for Pulmonary Metastases. Journal of Radiation Research, 55, 105-112.
https://doi.org/10.1093/jrr/rrt080

[19]   Khalil, A.A., Hoffmann, L., Moeller, D.S., et al. (2015) New Dose Constraint Reduces Radiation-Induced Fatal Pneumonitis in Locally Advanced Non-Small Cell Lung Cancer Patients Treated with Intensity-Modulated Radiotherapy. Acta Oncologica, 54, 1343-1349.
https://doi.org/10.3109/0284186X.2015.1061216

[20]   Baker, R., Han, G., Sarangkasiri, S., et al. (2013) Clinical and Dosimetric Predictors of Radiation Pneumonitis in a Large Series of Patients Treated with Stereotactic Radiation Therapy to the Lung. International Journal of Radiation Oncology Biology Physics, 85, 190-195.
https://doi.org/10.1016/j.ijrobp.2012.03.041

[21]   Theuws, J.C.M., Kwa, S.L.S., Wagenaar, A.C., et al. (1998) Dose-Effect Relations for Early Local Pulmonary Injury after Irradiation for Malignant Lymphoma and Breast Cancer. Radiotherapy and Oncology, 48, 33-43.
https://doi.org/10.1016/S0167-8140(98)00019-X

[22]   Marks, L.B., Munley, M.T., Spencer, D.P., et al. (1997) Quantification of Radiation-Induced Regional Lung Injury with Perfusion Imaging. International Journal of Radiation Oncology Biology Physics, 38, 399-409.
https://doi.org/10.1016/S0360-3016(97)00013-8

 
 
Top