Radiation pneumonitis for patients treated for malignant pulmonary lesions with stereotactic body radiation therapy

Purpose: We evaluated the relationship between the mean lung dose (MLD) and the incidence of radiation pneumonitis (RP) after SBRT and compared this with conventional fractionated radiation therapy (CFRT). Material and Methods: For both SBRT (n=128) and CFRT (n=142) patients, RP grade ≥ 2 was scored. Toxicity models predicting the probability of RP as a function of the MLD were fitted using maximum log likelihood analysis. The MLD was NTD (Normalized Total Dose) corrected using an ratio of 3 Gy. Results: SBRT patients were treated with 6 Gy to 12Gy per fraction with a median MLD of 6.4 Gy (range:1.5 Gy to 26.5 Gy). CFRT patients were treated with 2 Gy or 2.25Gy per fraction, the median MLD was 13.2Gy (range:3.0Gy to 23.0 Gy). The crude incidence rates of RP were 10.9% and 17.6% for the SBRT and CFRT patients, respectively. A significant dose-response relationship for RP was found after SBRT that was not significantly different from the doseresponse relationship for CFRT (p=0.18). Conclusion: We derived from clinical data a significant dose-response relationship between the risk of RP and the MLD for SBRT. This relation was not significantly different from the dose-response relation for CFRT although statistical analysis was hampered by the low number of patients in the high dose range. Radiation pneumonytis for Patients Treated for Malignant Pulmonary Lesions with SBRT

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