Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy: Risk factors and dose-volume relationship

Kaori Asai, Yoshiyuki Shioyama, Katsumasa Nakamura, Tomonari Sasaki, Ohga Saiji, Takeshi Nonoshita, Tadamasa Yoshitake, Kayoko Ohnishi, Kotaro Terashima, Keiji Matsumoto, Hideki Hirata, Hiroshi Honda

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Abstract

Purpose: The purpose of this study was to clarify the incidence, the clinical risk factors, and the dose-volume relationship of radiation-induced rib fracture (RIRF) after hypofractionated stereotactic body radiation therapy (SBRT). Methods and Materials: One hundred sixteen patients treated with SBRT for primary or metastatic lung cancer at our institution, with at least 6 months of follow-up and no previous overlapping radiation exposure, were included in this study. To determine the clinical risk factors associated with RIRF, correlations between the incidence of RIRF and the variables, including age, sex, diagnosis, gross tumor volume diameter, rib-tumor distance, and use of steroid administration, were analyzed. Dose-volume histogram analysis was also conducted. Regarding the maximum dose, V10, V20, V30, and V40 of the rib, and the incidences of RIRF were compared between the two groups divided by the cutoff value determined by the receiver operating characteristic curves. Results: One hundred sixteen patients and 374 ribs met the inclusion criteria. Among the 116 patients, 28 patients (46 ribs) experienced RIRF. The estimated incidence of rib fracture was 37.7% at 3 years. Limited distance from the rib to the tumor (<2.0 cm) was the only significant risk factor for RIRF (p = 0.0001). Among the dosimetric parameters used for receiver operating characteristic analysis, the maximum dose showed the highest area under the curve. The 3-year estimated risk of RIRF and the determined cutoff value were 45.8% vs. 1.4% (maximum dose, ≥42.4 Gy or less), 51.6% vs. 2.0% (V40, ≥0.29 cm3 or less), 45.8% vs. 2.2% (V30, ≥1.35 cm3 or less), 42.0% vs. 8.5% (V20, ≥3.62 cm3 or less), or 25.9% vs. 10.5% (V10, ≥5.03 cm3 or less). Conclusions: The incidence of RIRF after hypofractionated SBRT is relatively high. The maximum dose and high-dose volume are strongly correlated with RIRF.

Original languageEnglish
Pages (from-to)768-773
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume84
Issue number3
DOIs
Publication statusPublished - Nov 1 2012

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Rib Fractures
radiation therapy
Radiotherapy
Radiation
dosage
Ribs
radiation
incidence
Incidence
tumors
ROC Curve
cut-off
receivers
steroids
radiation dosage
curves
Tumor Burden
histograms
lungs
Area Under Curve

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy : Risk factors and dose-volume relationship. / Asai, Kaori; Shioyama, Yoshiyuki; Nakamura, Katsumasa; Sasaki, Tomonari; Saiji, Ohga; Nonoshita, Takeshi; Yoshitake, Tadamasa; Ohnishi, Kayoko; Terashima, Kotaro; Matsumoto, Keiji; Hirata, Hideki; Honda, Hiroshi.

In: International Journal of Radiation Oncology Biology Physics, Vol. 84, No. 3, 01.11.2012, p. 768-773.

Research output: Contribution to journalArticle

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abstract = "Purpose: The purpose of this study was to clarify the incidence, the clinical risk factors, and the dose-volume relationship of radiation-induced rib fracture (RIRF) after hypofractionated stereotactic body radiation therapy (SBRT). Methods and Materials: One hundred sixteen patients treated with SBRT for primary or metastatic lung cancer at our institution, with at least 6 months of follow-up and no previous overlapping radiation exposure, were included in this study. To determine the clinical risk factors associated with RIRF, correlations between the incidence of RIRF and the variables, including age, sex, diagnosis, gross tumor volume diameter, rib-tumor distance, and use of steroid administration, were analyzed. Dose-volume histogram analysis was also conducted. Regarding the maximum dose, V10, V20, V30, and V40 of the rib, and the incidences of RIRF were compared between the two groups divided by the cutoff value determined by the receiver operating characteristic curves. Results: One hundred sixteen patients and 374 ribs met the inclusion criteria. Among the 116 patients, 28 patients (46 ribs) experienced RIRF. The estimated incidence of rib fracture was 37.7{\%} at 3 years. Limited distance from the rib to the tumor (<2.0 cm) was the only significant risk factor for RIRF (p = 0.0001). Among the dosimetric parameters used for receiver operating characteristic analysis, the maximum dose showed the highest area under the curve. The 3-year estimated risk of RIRF and the determined cutoff value were 45.8{\%} vs. 1.4{\%} (maximum dose, ≥42.4 Gy or less), 51.6{\%} vs. 2.0{\%} (V40, ≥0.29 cm3 or less), 45.8{\%} vs. 2.2{\%} (V30, ≥1.35 cm3 or less), 42.0{\%} vs. 8.5{\%} (V20, ≥3.62 cm3 or less), or 25.9{\%} vs. 10.5{\%} (V10, ≥5.03 cm3 or less). Conclusions: The incidence of RIRF after hypofractionated SBRT is relatively high. The maximum dose and high-dose volume are strongly correlated with RIRF.",
author = "Kaori Asai and Yoshiyuki Shioyama and Katsumasa Nakamura and Tomonari Sasaki and Ohga Saiji and Takeshi Nonoshita and Tadamasa Yoshitake and Kayoko Ohnishi and Kotaro Terashima and Keiji Matsumoto and Hideki Hirata and Hiroshi Honda",
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T1 - Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy

T2 - Risk factors and dose-volume relationship

AU - Asai, Kaori

AU - Shioyama, Yoshiyuki

AU - Nakamura, Katsumasa

AU - Sasaki, Tomonari

AU - Saiji, Ohga

AU - Nonoshita, Takeshi

AU - Yoshitake, Tadamasa

AU - Ohnishi, Kayoko

AU - Terashima, Kotaro

AU - Matsumoto, Keiji

AU - Hirata, Hideki

AU - Honda, Hiroshi

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N2 - Purpose: The purpose of this study was to clarify the incidence, the clinical risk factors, and the dose-volume relationship of radiation-induced rib fracture (RIRF) after hypofractionated stereotactic body radiation therapy (SBRT). Methods and Materials: One hundred sixteen patients treated with SBRT for primary or metastatic lung cancer at our institution, with at least 6 months of follow-up and no previous overlapping radiation exposure, were included in this study. To determine the clinical risk factors associated with RIRF, correlations between the incidence of RIRF and the variables, including age, sex, diagnosis, gross tumor volume diameter, rib-tumor distance, and use of steroid administration, were analyzed. Dose-volume histogram analysis was also conducted. Regarding the maximum dose, V10, V20, V30, and V40 of the rib, and the incidences of RIRF were compared between the two groups divided by the cutoff value determined by the receiver operating characteristic curves. Results: One hundred sixteen patients and 374 ribs met the inclusion criteria. Among the 116 patients, 28 patients (46 ribs) experienced RIRF. The estimated incidence of rib fracture was 37.7% at 3 years. Limited distance from the rib to the tumor (<2.0 cm) was the only significant risk factor for RIRF (p = 0.0001). Among the dosimetric parameters used for receiver operating characteristic analysis, the maximum dose showed the highest area under the curve. The 3-year estimated risk of RIRF and the determined cutoff value were 45.8% vs. 1.4% (maximum dose, ≥42.4 Gy or less), 51.6% vs. 2.0% (V40, ≥0.29 cm3 or less), 45.8% vs. 2.2% (V30, ≥1.35 cm3 or less), 42.0% vs. 8.5% (V20, ≥3.62 cm3 or less), or 25.9% vs. 10.5% (V10, ≥5.03 cm3 or less). Conclusions: The incidence of RIRF after hypofractionated SBRT is relatively high. The maximum dose and high-dose volume are strongly correlated with RIRF.

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