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Prospective assessment of dosimetric/physiologic-based models for predicting radiation pneumonitis.

Publication ,  Journal Article
Kocak, Z; Borst, GR; Zeng, J; Zhou, S; Hollis, DR; Zhang, J; Evans, ES; Folz, RJ; Wong, T; Kahn, D; Belderbos, JSA; Lebesque, JV; Marks, LB
Published in: Int J Radiat Oncol Biol Phys
January 1, 2007

PURPOSE: Clinical and 3D dosimetric parameters are associated with symptomatic radiation pneumonitis rates in retrospective studies. Such parameters include: mean lung dose (MLD), radiation (RT) dose to perfused lung (via SPECT), and pre-RT lung function. Based on prior publications, we defined pre-RT criteria hypothesized to be predictive for later development of pneumonitis. We herein prospectively test the predictive abilities of these dosimetric/functional parameters on 2 cohorts of patients from Duke and The Netherlands Cancer Institute (NKI). METHODS AND MATERIALS: For the Duke cohort, 55 eligible patients treated between 1999 and 2005 on a prospective IRB-approved study to monitor RT-induced lung injury were analyzed. A similar group of patients treated at the NKI between 1996 and 2002 were identified. Patients believed to be at high and low risk for pneumonitis were defined based on: (1) MLD; (2) OpRP (sum of predicted perfusion reduction based on regional dose-response curve); and (3) pre-RT DLCO. All doses reflected tissue density heterogeneity. The rates of grade > or =2 pneumonitis in the "presumed" high and low risk groups were compared using Fisher's exact test. RESULTS: In the Duke group, pneumonitis rates in patients prospectively deemed to be at "high" vs. "low" risk are 7 of 20 and 9 of 35, respectively; p = 0.33 one-tailed Fisher's. Similarly, comparable rates for the NKI group are 4 of 21 and 6 of 44, respectively, p = 0.41 one-tailed Fisher's. CONCLUSION: The prospective model appears unable to accurately segregate patients into high vs. low risk groups. However, considered retrospectively, these data are consistent with prior studies suggesting that dosimetric (e.g., MLD) and functional (e.g., PFTs or SPECT) parameters are predictive for RT-induced pneumonitis. Additional work is needed to better identify, and prospectively assess, predictors of RT-induced lung injury.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

January 1, 2007

Volume

67

Issue

1

Start / End Page

178 / 186

Location

United States

Related Subject Headings

  • Risk Assessment
  • Respiratory Function Tests
  • Radiotherapy Dosage
  • Radiation Pneumonitis
  • ROC Curve
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Models, Biological
  • Middle Aged
  • Male
 

Citation

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Kocak, Z., Borst, G. R., Zeng, J., Zhou, S., Hollis, D. R., Zhang, J., … Marks, L. B. (2007). Prospective assessment of dosimetric/physiologic-based models for predicting radiation pneumonitis. Int J Radiat Oncol Biol Phys, 67(1), 178–186. https://doi.org/10.1016/j.ijrobp.2006.09.031
Kocak, Zafer, Gerben R. Borst, Jing Zeng, Sumin Zhou, Donna R. Hollis, Junan Zhang, Elizabeth S. Evans, et al. “Prospective assessment of dosimetric/physiologic-based models for predicting radiation pneumonitis.Int J Radiat Oncol Biol Phys 67, no. 1 (January 1, 2007): 178–86. https://doi.org/10.1016/j.ijrobp.2006.09.031.
Kocak Z, Borst GR, Zeng J, Zhou S, Hollis DR, Zhang J, et al. Prospective assessment of dosimetric/physiologic-based models for predicting radiation pneumonitis. Int J Radiat Oncol Biol Phys. 2007 Jan 1;67(1):178–86.
Kocak, Zafer, et al. “Prospective assessment of dosimetric/physiologic-based models for predicting radiation pneumonitis.Int J Radiat Oncol Biol Phys, vol. 67, no. 1, Jan. 2007, pp. 178–86. Pubmed, doi:10.1016/j.ijrobp.2006.09.031.
Kocak Z, Borst GR, Zeng J, Zhou S, Hollis DR, Zhang J, Evans ES, Folz RJ, Wong T, Kahn D, Belderbos JSA, Lebesque JV, Marks LB. Prospective assessment of dosimetric/physiologic-based models for predicting radiation pneumonitis. Int J Radiat Oncol Biol Phys. 2007 Jan 1;67(1):178–186.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

January 1, 2007

Volume

67

Issue

1

Start / End Page

178 / 186

Location

United States

Related Subject Headings

  • Risk Assessment
  • Respiratory Function Tests
  • Radiotherapy Dosage
  • Radiation Pneumonitis
  • ROC Curve
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Models, Biological
  • Middle Aged
  • Male