Chest wall toxicity after stereotactic body radiation therapy: a pooled-analysis of 57 studies
A partir d'une revue de la littérature (57 études), cette méta-analyse évalue, en fonction du sexe, les effets indésirables au niveau de la paroi thoracique (douleur, fractures des côtes) d'une radiothérapie stéréotaxique chez les patients atteints d'une tumeur pulmonaire
Purpose : The significance of clinical and dosimetric risk factors in relation to chest wall (CW) injury after stereotactic body radiation therapy (SBRT) for lung tumors were analyzed through a meta-analysis of 57 published studies. Methods and materials : Studies related to CW injury after lung SBRT were obtained through searching PubMed, Embase and Cochrane electronic databases. An estimate of the incidence of CW pain (CWP) or rib fracture (RF) was derived using a Bayesian hierarchical model. Linear regression analysis was performed to assess the relationship between CWP or RF and clinical or dosimetric factors. Results : A total of 57 studies incorporating 5,985 cases reporting clinical data on CW injury after SBRT were analyzed. The overall CWP and RF rates by Bayesian hierarchical modeling were 11.0% (95% CI: 8.0–14.4) and 6.3% (95% CI: 3.7–9.7), respectively. The rates of grade ≥2 and grade ≥3 CWP were 6.2% (95% CI: 3.88–8.93) and 1.2% (95% CI: 0.48–2.12), respectively. Gender was significantly correlated with RF (P<0.001), with female patients having a greater risk of RF than male patients (HR=0.59, 95% CI: 0.46–0.76). No correlation was found between RF, grade ≥2 or grade ≥3 CWP, with the clinical and dosimetric factors of age, tumor size, origin of lung tumor, gross tumor volume, planning target volume, fractional dose, number of fractions or biologically effective dose. However, tumor to CW distance (TCD) (<16–25 mm), body mass index, maximum dose (Dmax) to 0.5-5 cubic centimeter and the volume of CW or ribs receiving >30 Gy were significantly associated with CWP and RF. Conclusions : The overall rates of RF and grade ≥2 CWP after thoracic SBRT are relatively low. Gender, TCD, Dmax and the radiation exposure of the CW or ribs are factors associated with the risk of CW toxicity after SBRT.