Dose-volume factors contributing to the incidence of radiation pneumonitis in non-small-cell lung cancer patients treated with three-dimensional conformal radiation therapy

Purpose: To analyze acute lung toxicity data of non-small-cell lung cancer patients treated with three-dimensional conformal radiation therapy in terms of dosimetric variables, location of dose within subvolumes of the lungs, and models of normal-tissue complication probability (NTCP). Methods and Materials: Dose distributions of 49 non-small-cell lung cancer patients treated in a dose escalation protocol between 1992 and 1999 were analyzed (dose range: 57.6-81 Gy). Nine patients had RTOG Grade 3 or higher acute lung toxicity. Correlation with dosimetric and physical variables, as well as Lyman and parallel NTCP models, was assessed. Lungs were evaluated as a single structure, as superior and inferior halves (to assess significance of dose to upper and lower lungs), and as ipsilateral and contralateral lungs. Results: For the whole lung, Grade 3 or higher pneumonitis was significantly correlated (p less than or equal to 0.05) with mean dose and Lyman and parallel model indices (d(eff) and f(dam)). It was significantly correlated with these indices and with V20 for the ipsilateral lung and with mean dose and doff for the inferior half of the lungs. Dosimetric and NTCP model quantities for the superior half of the lungs and contralateral lung were not significantly correlated (p > 0.5 for superior lung indices, and >0.1 for contralateral lung indices studied). Conclusions: For these patients, commonly used dosimetric and NTCP models are significantly correlated with Grade 3 pneumonitis. Equivalently strong correlations are found in the lower portion of the lungs and the ipsilateral lung, but not in the upper portion or contralateral lung. (C) 2002 Elsevier Science Inc.