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Predictors of post-treatment symptomatic pneumonitis in lung SBRT patients through decision tree analysis

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Purpose

The objective of this study is to identify clinical and dosimetric factors for lung stereotactic body radiation therapy (SBRT) that can predict the development of post-treatment symptomatic pneumonitis.

Materials and methods

We retrospectively analyzed 65 patients with a total of 68 lung lesions treated with SBRT from 2011 to 2013. The post-treatment time period was defined from the patient’s last fraction until the most recent follow-up. Toxicity was graded according to NCI CTCAE v4.0. Pulmonary symptoms grade 2 and greater were considered symptomatic. Twenty-six patient, tumor, and dosimetric parameters were used to train the decision tree in order to predict post-treatment symptomatic pneumonitis.

Results

Median follow-up was 10.8 months (range 3–32 months). Seven patients experienced grade 2 and 1 patient experienced grade 3 pneumonitis in the post-treatment period. Crude rate of symptomatic post-treatment pneumonitis was 12.3 %. Of the 26 factors that trained the decision tree, 4 factors were found to be predictive of developing post-treatment symptomatic pneumonitis: history of prior radiation therapy, lung V20, conformality index (CI) at the 50 % isodose line, and contralateral lung V5. If a patient had prior lung irradiation, V20 >4.1 % was a risk factor for developing post-treatment symptomatic pneumonitis. If a patient had no prior history of radiation, CI at the 50 % isodose line >5.1 and contralateral lung V5 >1.66 % were found to be risk factors for developing post-treatment symptomatic pneumonitis. Overall, this decision tree modeled our post-treatment clinical outcomes with 94 % prediction accuracy.

Conclusion

Based on this retrospective analysis, post-treatment symptomatic pneumonitis was successfully predicted by this developed decision tree using 4 readily available clinical and dosimetric factors. Using this decision tree, it is possible to identify lung SBRT patients at higher risk of developing symptomatic pneumonitis. These findings warrant validation with an external dataset and subsequent testing in a prospective study.

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Authors and Affiliations

  1. Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA

    Katarina Petras, Murat Surucu, Fiori Alite, Karan Shah, Bahman Emami, William Small Jr. & Matthew M. Harkenrider

  2. Department of Management Information Systems, Lewis University, Romeoville, IL, USA

    Ibrahim Mescioglu

Authors
  1. Katarina Petras
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  2. Murat Surucu
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  3. Ibrahim Mescioglu
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  4. Fiori Alite
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  5. Karan Shah
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  6. Bahman Emami
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  7. William Small Jr.
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  8. Matthew M. Harkenrider
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Corresponding author

Correspondence to Matthew M. Harkenrider.

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Petras, K., Surucu, M., Mescioglu, I. et al. Predictors of post-treatment symptomatic pneumonitis in lung SBRT patients through decision tree analysis. J Radiat Oncol 5, 273–278 (2016). https://doi.org/10.1007/s13566-016-0258-3

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  • DOI: https://doi.org/10.1007/s13566-016-0258-3

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