立体定向体部放疗治疗早期非小细胞肺癌后出现症状性放射性肋骨骨折。
Symptomatic radiation-induced rib fractures after stereotactic body radiotherapy for early-stage non-small cell lung cancer.
作者信息
Kita Nozomi, Tomita Natsuo, Takaoka Taiki, Matsuura Akane, Okazaki Dai, Niwa Masanari, Torii Akira, Takano Seiya, Mekata Yuji, Niimi Akio, Hiwatashi Akio
机构信息
Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
出版信息
Clin Transl Radiat Oncol. 2023 Sep 25;43:100683. doi: 10.1016/j.ctro.2023.100683. eCollection 2023 Nov.
BACKGROUND AND PURPOSE
The present study investigated the relationships between the risk of radiation-induced rib fractures (RIRF) and clinical and dosimetric factors in stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). We also examined dosimetric parameters associated with symptomatic or asymptomatic RIRF and the dosimetric threshold for symptomatic RIRF.
MATERIALS AND METHODS
We reviewed 244 cases of early-stage NSCLC treated with SBRT. Gray's test and the Fine-Gray model were performed to examine the relationships between clinical and dosimetric factors and grade ≥ 2 (i.e., symptomatic) RIRF. The effects of each dose parameter on grade ≥ 1 and ≥ 2 RIRF were assessed with the Fine-Gray model. The -test was used to compare each dose parameter between the grade 1 and grade ≥ 2 groups. Optimal thresholds were tested using receiver operating characteristic (ROC) curves.
RESULTS
With a median follow-up period of 48 months, the 4-year cumulative incidence of grade ≥ 1 and grade ≥ 2 RIRF were 26.4 % and 8.0 %, respectively. Regarding clinical factors, only age was associated with the development of grade ≥ 2 RIRF (p = 0.024). Among dosimetric parameters, only V40Gy significantly differed between the grade 1 and grade ≥ 2 groups (p = 0.015). The ROC curve analysis of grade ≥ 2 RIRF showed that the optimal diagnostic thresholds for D3cc, D4cc, D5cc, and V40Gy were 45.86 Gy (area under the curve [AUC], 0.706), 39.02 Gy (AUC, 0.705), 41.62 Gy (AUC, 0.702), and 3.83 cc (AUC, 0.730), respectively. These results showed that V40Gy ≤ 3.83 cc was the best indicator of grade ≥ 2 RIRF. The 4-year incidence of grade ≥ 2 RIRF in the V40Gy ≤ 3.83 cc vs. > 3.83 cc groups was 1.8 % vs. 14.2 % (p = 0.001).
CONCLUSION
The present results recommend V40Gy ≤ 3.83 cc as the threshold for grade ≥ 2 RIRF in SBRT.
背景与目的
本研究调查了立体定向体部放射治疗（SBRT）用于早期非小细胞肺癌（NSCLC）时，放射性肋骨骨折（RIRF）风险与临床及剂量学因素之间的关系。我们还研究了与有症状或无症状RIRF相关的剂量学参数以及有症状RIRF的剂量学阈值。
材料与方法
我们回顾了244例接受SBRT治疗的早期NSCLC病例。采用Gray检验和Fine-Gray模型来研究临床和剂量学因素与2级及以上（即有症状的）RIRF之间的关系。使用Fine-Gray模型评估每个剂量参数对1级及以上和2级及以上RIRF的影响。采用t检验比较1级和2级及以上组之间的每个剂量参数。使用受试者工作特征（ROC）曲线测试最佳阈值。
结果
中位随访期为48个月，1级及以上和2级及以上RIRF的4年累积发生率分别为26.4%和8.0%。关于临床因素，只有年龄与2级及以上RIRF的发生相关（p = 0.024）。在剂量学参数中，只有V40Gy在1级和2级及以上组之间有显著差异（p = 0.015）。2级及以上RIRF的ROC曲线分析表明，D3cc、D4cc、D5cc和V40Gy的最佳诊断阈值分别为45.86 Gy（曲线下面积[AUC]，0.706）、39.02 Gy（AUC，0.705）、41.62 Gy（AUC，0.702）和3.83 cc（AUC，0.730）。这些结果表明，V40Gy≤3.83 cc是2级及以上RIRF的最佳指标。V40Gy≤3.83 cc组与>3.83 cc组2级及以上RIRF的4年发生率分别为1.8%和14.2%（p = 0.001）。
结论
本研究结果推荐V40Gy≤3.83 cc作为SBRT中2级及以上RIRF的阈值。
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