| Dose constraints to prevent radiation-induced brachial plexopathy in patients treated for lung cancer. | |
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MedLine Citation:
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PMID: 22284035 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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PURPOSE: As the recommended radiation dose for non-small-cell lung cancer (NSCLC) increases, meeting dose constraints for critical structures like the brachial plexus becomes increasingly challenging, particularly for tumors in the superior sulcus. In this retrospective analysis, we compared dose-volume histogram information with the incidence of plexopathy to establish the maximum dose tolerated by the brachial plexus. METHODS AND MATERIALS: We identified 90 patients with NSCLC treated with definitive chemoradiation from March 2007 through September 2010, who had received >55 Gy to the brachial plexus. We used a multiatlas segmentation method combined with deformable image registration to delineate the brachial plexus on the original planning CT scans and scored plexopathy according to Common Terminology Criteria for Adverse Events version 4.03. RESULTS: Median radiation dose to the brachial plexus was 70 Gy (range, 56-87.5 Gy; 1.5-2.5 Gy/fraction). At a median follow-up time of 14.0 months, 14 patients (16%) had brachial plexopathy (8 patients [9%] had Grade 1, and 6 patients [7%] had Grade ≥2); median time to symptom onset was 6.5 months (range, 1.4-37.4 months). On multivariate analysis, receipt of a median brachial plexus dose of >69 Gy (odds ratio [OR] 10.091; 95% confidence interval [CI], 1.512-67.331; p = 0.005), a maximum dose of >75 Gy to 2 cm(3) of the brachial plexus (OR, 4.909; 95% CI, 0.966-24.952; p = 0.038), and the presence of plexopathy before irradiation (OR, 4.722; 95% CI, 1.267-17.606; p = 0.021) were independent predictors of brachial plexopathy. CONCLUSIONS: For lung cancers near the apical region, brachial plexopathy is a major concern for high-dose radiation therapy. We developed a computer-assisted image segmentation method that allows us to rapidly and consistently contour the brachial plexus and establish the dose limits to minimize the risk of brachial plexopathy. Our results could be used as a guideline in future prospective trials with high-dose radiation therapy for unresectable lung cancer. |
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Authors:
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Arya Amini; Jinzhong Yang; Ryan Williamson; Michelle L McBurney; Jeremy Erasmus; Pamela K Allen; Mandar Karhade; Ritsuko Komaki; Zhongxing Liao; Daniel Gomez; James Cox; Lei Dong; James Welsh |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: International journal of radiation oncology, biology, physics Volume: 82 ISSN: 1879-355X ISO Abbreviation: Int. J. Radiat. Oncol. Biol. Phys. Publication Date: 2012 Mar |
Date Detail:
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Created Date: 2012-01-30 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7603616 Medline TA: Int J Radiat Oncol Biol Phys Country: United States |
Other Details:
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Languages: eng Pagination: e391-8 Citation Subset: IM |
Copyright Information:
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Copyright © 2012 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas; University of California Irvine School of Medicine, Irvine, California. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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