Clinical dose-volume histogram analysis for pneumonitis after 3D treatmentfor non-small cell lung cancer (NSCLC)

Purpose: To identify a clinically relevant and available parameter upon whi ch to identify non-small cell lung cancer (NSCLC) patients at risk for pneu monitis when treated with three-dimensional (3D) radiation therapy. Methods and Materials: Between January 1991 and October 1995, 99 patients w ere treated definitively for inoperable NSCLC. Patients were selected for g ood performance status (96%) and absence of weight loss (82%). All patients had full 3D treatment planning (including total lung dose-volume histogram s [DVHs]) prior to treatment delivery. The total lung DVH parameters were c ompared with the incidence and grade of pneumonitis after treatment. Results: Univariate analysis revealed the percent of the total lung volume exceeding 20 Gy (V-20), the effective volume (V-eff) and the total lung vol ume mean dose, and location of the tumor primary (upper versus lower lobes) to be statistically significant relative to the development of greater tha n or equal to Grade 2 pneumonitis. Multivariate analysis revealed the V-20 to be the single independent predictor of pneumonitis. Conclusions: The V-20 from the total lung DVH is a useful parameter easily obtained from most 3D treatment planning systems. The V-20 may be useful in comparing competing treatment plans to evaluate the risk of pneumonitis fo r our individual patient treatment and may also be a useful parameter upon which to stratify patients or prospective dose escalation trials. (C) 1999 Elsevier Science Inc.