Complication probability for radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT)
Jimm Grimm, David Palma, Suresh Senan and Jinyu Xue
Purpose/Objective: To determine clinically relevant SBRT/stereotactic ablative radiotherapy (SABR) dose tolerance limits for RP based on statistical analysis of outcomes data.
Materials and Methods: Eighteen consecutive patients who were treated using volumetric modulated arc therapy (RapidArc) for lung tumors exceeding 80cc were assessed. Clinical outcomes have been published elsewhere, and here we present a normal tissue complication probability (NTCP) analysis. The dose volume histogram (DVH) reduction techniques of total lung V20Gy, V15Gy, V10Gy, V5Gy and mean lung dose (MLD) were each analyzed, as well as ipsilateral lung V5Gy and contralateral lung V5Gy, using the DVH Evaluator software tool. The framework of the Lyman Model was used except that each DVH reduction method was analyzed independently instead of using the power-law relationship for volume dependence. Model parameters were fitted using Maximum Likelihood.
Results: RP was reported in 5 patients (CTC Grade 2 in 3, and Grade 3 in 2). Total lung V5Gy and contralateral lung V5Gy were the best predictors of RP (p < 0.0001 for both). For V5Gy, the 10% risk level for Grade 2-3 RP was 27.9% for total lung and 21.8% for contralateral lung. For V20Gy, the 25% risk level is 10.5% of total lung.
Conclusions: Analysis of RP endpoints has identified total lung V5Gy and contralateral lung V5Gy as the best predictors of RP following SBRT when delivered with RapidArc. These findings are based on limited clinical data, and longer follow-up in larger patient cohorts is required in order to determine more accurate dose tolerance limits.
Keywords: Stereotactic Radiosurgery, Gamma Knife, Treatment Planning, Volume Staging, Arteriovenous Malformation