Obesity increases the risk of chest wall pain from thoracic stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys

Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
International journal of radiation oncology, biology, physics (Impact Factor: 4.18). 09/2011; 81(1):91-6. DOI: 10.1016/j.ijrobp.2010.04.022
Source: PubMed

ABSTRACT Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT.
We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0.
Of 360 patients in the database, 265 (268 tumors) had tumors within <2.5 cm of the chest wall; 104 (39%) developed skin toxicity (any grade); 14 (5%) developed acute pain (any grade), and 45 (17%) developed chronic pain (Grade 1 in 22 cases [49%] and Grade 2 or 3 in 23 cases [51%]). Both skin toxicity and chest wall pain were associated with the V30, or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI≥29 had almost twice the risk of chronic pain (p=0.03). Among patients with BMI>29, diabetes mellitus was a significant contributing factor to the development of chest pain.
Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.

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    • "The use of only three beams, distance from the tumour to the posterior chest wall skin of less than 5 cm and a maximum skin dose 50% of the prescribed dose were found to be risk factors for grade 2 or higher acute skin toxicity [7]. In a study from MDACC, the volume of the chest wall receiving 30 Gy in four fractions predicted the risk of skin toxicity among patients with lung tumours within 2.5 cm from the chest wall [21]. "
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    • "Despite a wide variety of dose and fractionation schedules, V30 in absolute cc's has consistently been reported as a significant risk factor for the development of CW pain [11] [13] [14] [17]. Our data also support V30 (and other dose levels) as a significant risk factor for CW pain; however our data demonstrate the percentage of CW receiving 30 Gy as predictive of CW pain rather than absolute cc's. "
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