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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy of non-small cell lung cancer: a dose- and volume-response analysis.
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Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy of non-small cell lung cancer: a dose- and volume-response analysis.

机译：非小细胞肺癌超分割立体定向放射治疗后放射诱发的肋骨骨折：剂量和体积反应分析。

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BACKGROUND AND PURPOSE: The aim of this study is to analyse the dose-response and the volume-response of radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS: During the period 1998-2005, 68 patients with medically inoperable stage I non-small cell lung cancer (NSCLC) were treated with hypofractionated SBRT to 45 Gy in 3 fractions. Among the 33 patients with complete treatment records and radiographic follow-up exceeding 15 months (median: 29 months), 13 fractures were found in seven patients. Identifying all ribs receiving at least 21 Gy, 81 ribs (13 with and 68 without fracture) in 26 patients were separately contoured and their dose-volume histograms (DVHs) were obtained. The DVHs were assessed with the mean dose and cut-off models. Maximum likelihood estimation was used to fit dose-response and volume-response curves to each model. RESULTS: It was possible to quantify the risk of radiation-induced rib fracture using response curves and information contained in the DVHs. Absolute volumes provided better fits than relative volumes and dose-response curves were more suitable than volume-response curves. For the dose given by the 2 cm(3) cut-off volume, D(2 cm(3)), the logistic dose-response curve for three fractions was parameterised by D(50)=49.8 Gy and gamma(50)=2.05. Consequently, for a median follow-up of 29 months, if D(2 cm(3))<3 x 7.0 Gy the risk is close to 0, and the 5% and 50% risks are given by D(2 cm(3))=3 x 9.1 Gy and 3 x 16.6 Gy, respectively. CONCLUSIONS: In this group of patients, the risk for radiation-induced rib fracture following hypofractionated SBRT was related to the dose to 2 cm(3) of the rib.
机译：背景与目的：本研究的目的是分析超分割立体定向放射治疗（SBRT）后放射线诱发的肋骨骨折的剂量反应和体积反应。材料与方法：在1998年至2005年期间，对68例医学上不能手术的I期非小细胞肺癌（NSCLC）患者进行了3次分次SBRT至45 Gy治疗。在33例具有完整治疗记录且影像学随访超过15个月（中位数：29个月）的患者中，有7例发现13处骨折。确定所有接受至少21 Gy的肋骨后，分别对26例患者中的81根肋骨（13处有骨折和68处没有骨折）进行轮廓绘制，并获得其剂量体积直方图（DVH）。用平均剂量和截断模型评估DVH。最大似然估计用于拟合每个模型的剂量反应和体积反应曲线。结果：可以使用DVHs中的响应曲线和信息来量化辐射诱发的肋骨骨折的风险。绝对体积比相对体积提供更好的拟合，并且剂量响应曲线比体积响应曲线更合适。对于2 cm（3）截止体积D（2 cm（3））给出的剂量，三部分的逻辑剂量响应曲线由D（50）= 49.8 Gy和gamma（50）= 2.05。因此，对于29个月的中位随访，如果D（2 cm（3））<3 x 7.0 Gy，则风险接近0，而5％和50％的风险由D（2 cm（3 ））= 3 x 9.1 Gy和3 x 16.6 Gy。结论：在这组患者中，SBRT分割后放射引起的肋骨骨折的风险与2 cm（3）的肋骨剂量有关。

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