Murray Louise, Karakaya Ebru, Hinsley Samantha, Naisbitt Mitchell, Lilley John, Snee Michael, Clarke Katy, Musunuru Hima B, Ramasamy Satiavani, Turner Rob, Franks Kevin
1 Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds, UK.
2 Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
Br J Radiol. 2016;89(1058):20150628. doi: 10.1259/bjr.20150628.
To investigate chest wall pain in patients with peripheral early stage lung cancer treated with stereotactic ablative radiotherapy (SABR), and to identify factors predictive of Common Terminology Criteria of Adverse Events Grade 2 + chest wall pain.
Patients who received 55 Gy in five fractions were included. A chest wall structure was retrospectively defined on planning scans, and chest wall dosimetry and tumour-related factors recorded. Logistic regression was performed to identify factors predictive of ≥Grade 2 chest wall pain.
182 patients and 187 tumours were included. There were 20 (10.9%) episodes of ≥Grade 2 chest wall pain. Multivariate logistic regression demonstrated that the maximum dose received by 1 cm(3) of chest wall (Dmax1 cm(3)) and tumour size were significant predictors of ≥Grade 2 chest wall pain [Dmax1 cm(3) odds ratio : 1.104, 95% confidence interval : 1.012-1.204, p = 0.025; tumour size (mm) odds ratio : 1.080, 95% confidence interval : 1.026-1.136, p = 0.003]. This model was an adequate fit to the data (Hosmer and Lemeshow test non-significant) and a fair discriminator for chest wall pain (area under receiver-operating characteristic curve: 0.74). Using the multivariate logistic regression model, parameters for Dmax1 cm(3) are provided, which predict <10% and <20% risks of ≥Grade 2 chest wall pain for different tumour sizes.
Grade 2+ chest wall pain is an uncommon side effect of lung SABR. Larger tumour size and increasing Dmax1 cm(3) are significant predictors of ≥Grade 2 chest wall pain. When planning lung SABR, it is prudent to try to avoid hot volumes in the chest wall, particularly for larger tumours.
This article demonstrates that Grade 2 or greater chest wall pain following lung SABR is more common when the tumour is larger in size and the Dmax1 cm(3) of the chest wall is higher. When planning lung SABR, the risk of chest wall pain may be reduced if maximum doses are minimized, particularly for larger tumours.
探讨接受立体定向消融放疗（SABR）的外周早期肺癌患者的胸壁疼痛情况，并确定预测不良事件通用术语标准2级及以上胸壁疼痛的因素。
纳入接受5次分割、每次55 Gy放疗的患者。在计划扫描上回顾性定义胸壁结构，并记录胸壁剂量测定和肿瘤相关因素。进行逻辑回归分析以确定预测≥2级胸壁疼痛的因素。
纳入182例患者和187个肿瘤。有20例（10.9%）发生≥2级胸壁疼痛。多因素逻辑回归分析表明，1 cm³胸壁接受的最大剂量（Dmax1 cm³）和肿瘤大小是≥2级胸壁疼痛的显著预测因素[Dmax1 cm³比值比：1.104，95%置信区间：1.012 - 1.204，p = 0.025；肿瘤大小（mm）比值比：1.080，95%置信区间：1.026 - 1.136，p = 0.003]。该模型与数据拟合良好（Hosmer和Lemeshow检验无显著性），对胸壁疼痛有较好的鉴别能力（受试者操作特征曲线下面积：0.74）。使用多因素逻辑回归模型，给出了Dmax1 cm³的参数，可预测不同肿瘤大小下≥2级胸壁疼痛风险<10%和<20%的情况。
2级及以上胸壁疼痛是肺部SABR少见的副作用。肿瘤体积较大和Dmax1 cm³增加是≥2级胸壁疼痛的显著预测因素。在计划肺部SABR时，谨慎的做法是尽量避免胸壁出现高剂量区容积，尤其是对于较大肿瘤。
本文表明，肺部SABR后发生2级或更高等级胸壁疼痛在肿瘤体积较大且胸壁Dmax1 cm³较高时更为常见。在计划肺部SABR时，如果将最大剂量降至最低，胸壁疼痛风险可能会降低，尤其是对于较大肿瘤。
