ACUTE SKIN TOXICITY FOLLOWING STEREOTACTIC BODY RADIATION THERAPY FOR STAGE I NON-SMALL-CELL LUNG CANCER: WHO'S AT RISK?

作者：Hoppe Bradford S; Laser Benjamin; Kowalski Alex V; Fontenla Sandra C; Pena Greenberg Elizabeth; Yorke Ellen D; Lovelock D Michael; Hunt Margie A; Rosenzweig Kenneth E^*

来源：International Journal of Radiation Oncology, Biology, Physics, 2008, 72(5): 1283-1286.

DOI：10.1016/j.ijrobp.2008.08.036

• Stereotactic body radiation therapy
• Lung cancer
• Skin toxicity
• Intensity-modulated radiation therapy
• Image-guided radiation therapy

Purpose: We examined the rate of acute skin toxicity within a prospectively managed database of patients treated for early-stage non-small-cell lung cancer (NSCLC) and investigated factors that might predict skin toxicity.
Methods: From May 2006 through January 2008,50 patients with Stage I NSCLC were treated at Memorial Sloan-Kettering Cancer Center with 60 Gy in three fractions or 44-48 Gy in four fractions. Patients were treated with multiple coplanar beams (3-7, median 4) with a 6 MV linac using intensity-modulated radiotherapy (IMRT) and dynamic multileaf collimation. Toxicity grading was performed and based on the National Cancer Institute Common Terminology Criteria for Adverse Effects. Factors associated with Grade 2 or higher acute skin reactions were calculated by Fisher's exact test.
Results: After a minimum 3 months of follow-up, 19 patients (38%) developed Grade 1, 4 patients (8%) Grade 2, 2 patients (4%) Grade 3, and I patient Grade 4 acute skin toxicity. Factors associated with Grade 2 or higher acute skin toxicity included using only 3 beams (p = 0.0007), distance from the tumor to the posterior chest wall skin of less than 5 cm (p = 0.006), and a maximum skin dose of 50% or higher of the prescribed dose (P = 0.02).
Conclusions: SBRT can be associated with significant skin toxicity. One must consider the skin dose when evaluating the treatment plan and consider the bolus effect of immobilization devices.

• 出版日期2008-12-1