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Modeling radiation pneumonitis of pulmonary stereotactic body radiotherapy: The impact of a local dose–effect relationship for lung perfusion loss


Selvaraj, Jothybasu; Lebesque, Joos; Hope, Andrew; Guckenberger, Matthias; Werner-Wasik, Maria; Peulen, Heike; Giuliani, Meredith; Mantel, Frederick; Belderbos, José; Grills, Inga; Sonke, Jan-Jakob (2019). Modeling radiation pneumonitis of pulmonary stereotactic body radiotherapy: The impact of a local dose–effect relationship for lung perfusion loss. Radiotherapy and Oncology, 132:142-147.

Abstract

Purpose: To investigate if a local dose-effect (LDE) relationship for perfusion loss improves the NTCP model fit for SBRT induced radiation pneumonitis (RP) compared to conventional LDEs.

Methods and materials: Multi-institutional data of 1015 patients treated with SBRT were analyzed. Dose distributions were converted to NTD with α/β = 3 Gy. The Lyman-Kutcher-Burman NTCP model was fitted to the incidence grade ≥2 RP by maximum likelihood estimation with mean lung dose (MLD), equivalent uniform doses (EUD) using three LDE functions (power-law (EUDpower), logistic with 2 free parameters (EUDlog-free) and logistic with fixed parameters describing local perfusion loss (EUDPerfusion)) and volume above a threshold dose (Vx). Models were compared with the Akaike weights (Aw) derived from the Akaike information criteria (AIC).

Results: The median time to grade ≥2 RP was 4.2 months and plateaued after 17 months at 5.4%. A strong dose-effect relationship for RP incidence was observed. The EUDPerfusion based NTCP model had the lowest AIC. The Aw were 0.53, 0.19, 0.11, 0.11, 0.05 for the EUDPerfusion, Vx, MLD, EUDlog-free and EUDpower LDEs respectively.

Conclusion: A LDE for perfusion loss provided modest improvement in NTCP model fit for SBRT induced radiation pneumonitis.

Abstract

Purpose: To investigate if a local dose-effect (LDE) relationship for perfusion loss improves the NTCP model fit for SBRT induced radiation pneumonitis (RP) compared to conventional LDEs.

Methods and materials: Multi-institutional data of 1015 patients treated with SBRT were analyzed. Dose distributions were converted to NTD with α/β = 3 Gy. The Lyman-Kutcher-Burman NTCP model was fitted to the incidence grade ≥2 RP by maximum likelihood estimation with mean lung dose (MLD), equivalent uniform doses (EUD) using three LDE functions (power-law (EUDpower), logistic with 2 free parameters (EUDlog-free) and logistic with fixed parameters describing local perfusion loss (EUDPerfusion)) and volume above a threshold dose (Vx). Models were compared with the Akaike weights (Aw) derived from the Akaike information criteria (AIC).

Results: The median time to grade ≥2 RP was 4.2 months and plateaued after 17 months at 5.4%. A strong dose-effect relationship for RP incidence was observed. The EUDPerfusion based NTCP model had the lowest AIC. The Aw were 0.53, 0.19, 0.11, 0.11, 0.05 for the EUDPerfusion, Vx, MLD, EUDlog-free and EUDpower LDEs respectively.

Conclusion: A LDE for perfusion loss provided modest improvement in NTCP model fit for SBRT induced radiation pneumonitis.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Radiation Oncology
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Oncology, Radiology Nuclear Medicine and imaging, Hematology
Language:English
Date:1 March 2019
Deposited On:14 Feb 2020 09:59
Last Modified:16 Feb 2020 07:08
Publisher:Elsevier
ISSN:0167-8140
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.radonc.2018.12.015
PubMed ID:30825963

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