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An increasing number of clinical studies suggest that some dosimetric factors (e.g. V20, V30, mean lung dose) should be considered for limiting the risk of lung toxicity.
Aiming at improving local control without increasing toxicity, we designed a multi-centre phase-III trial delivering inhomogeneous dose-escalation driven by FDG-avid volumes, while respecting normal tissue constraints and requiring no increase in mean lung dose.
The best configuration of the holder ensures an almost uniform thermal neutron flux inside the lungs (Φmax/Φmin=1.5), an irradiation time about 10 min long, to deliver at least 40 Gyw to the tumor, a mean lung dose of 5.9±0.4 Gyw, and doses absorbed by all the other healthy tissues below the tolerance limits.
Such parameters include: mean lung dose (MLD), radiation (RT) dose to perfused lung (via SPECT), and pre-RT lung function.
Similarly, mean lung dose (P<.01) and lung V5 (volume receiving 5 Gy or more; P<.01) values decreased with increasing experience.
Among the input features selected by model SVM all), the two with highest importance for predicting lung pneumonitis were: (a) generalized equivalent uniform doses close to the mean lung dose, and (b) chemotherapy prior to radiotherapy.
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Current average mean lung doses are around 7 18 Gy for the ipsilateral, and around 0.1 3 Gy for the contralateral lung (Jagsi et al, 2010; Schubert et al, 2011).
Moreover, the whole-course V20 and mean total lung dose were 10% and 10.24 Gy, respectively.
The mean ipsilateral lung dose using HTgF was not significantly greater than STgF (6 vs. 5 Gy; p = 0.2).
The mean applied total lung dose was 12.31 Gy (SD = 2.64 Gy) based on a mean ipsilateral lung dose of 19.85 Gy (SD = 4.03 Gy) and a mean contralateral lung dose of 6.52 Gy (SD = 3.34 Gy).
Mean lung deposition expressed as a percent of nominal dose was 10.5 ± 3.0% and 15.1 ± 5.0% during PS and VC, respectively (p < 0.05).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com