Originally published as JCO Early Release 10.1200/JCO.2008.20.0121 on July 20 2009

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Lung Dose-Volume Parameters and the Risk of Pneumonitis for Patients Treated With Accelerated Partial-Breast Irradiation Using Three-Dimensional Conformal Radiotherapy

From the Beth Israel Deaconess Medical Center; Massachusetts General Hospital; Boston Medical Center; the Harvard Medical School, Boston, MA; and the Department of Radiation Oncology, Tanta University Hospital, Tanta Faculty of Medicine, Egypt.

Corresponding author: Abram Recht, MD, Beth Israel Deaconess Medical Center, Department of Radiation Oncology, East Campus, Finard Building B25, 330 Brookline Ave, Boston MA 02215; e-mail: arecht{at}bidmc.harvard.edu.

Purpose There are no data on how complication rates after accelerated partial-breast irradiation delivered by three-dimensional conformal radiotherapy are affected by treatment technique. We therefore examined the risk of pneumonitis in relation to lung dose-volume parameters.

Patients and Methods Our prospective dose-escalation trial enrolled 198 treated patients from 2003 to 2007. Patients received 32 or 36 Gy in 4-Gy fractions, given twice daily: 29 (14%) were treated with pure photons; 149 (77%) with mixed photons and electrons; and 20 (10%) with protons.

Results There were four cases of pneumonitis at 4, 4, 7, and 9 months after treatment. All were in the 36-Gy cohort and were treated with pure photons. The risk of pneumonitis for the two cohorts combined was: 17% (four of 24) for an ipsilateral lung volume (ILV) receiving 20 Gy or higher (ILV, 20 Gy) of 3% or higher (P = .0002 for comparison to ILV 20 Gy < 3%, Fisher's exact test); 20% (four of 20) for an ILV 10 Gy of 10% or higher (P = .0001); and 15% (four of 26) for an ILV 5 Gy of 20% or higher (P = .0002).

Conclusion The risk of pneumonitis appeared related to the ILV treated. This volume can be reduced by using mixed photons and electron when possible. We recommend that the ILV 20 Gy should be lower than 3%, the ILV 10 Gy lower than 10%, and the ILV 5 Gy lower than 20% when purely coplanar techniques are used.

Supported in part by grants from the Susan G. Komen for the Cure Foundation, the Jane Mailloux Research Fund, the Blanche Montesi Fund, and the Tim Levy Fund for Breast Cancer Research.

Presented in part at the 50th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Boston, MA, September 21-25, 2008.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Clinical trial information can be found for the following: NCT00694577 [ClinicalTrials.gov] .

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