Predictors and management of chest wall toxicity after lung stereotactic body radiotherapy.pdf

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Predictors and management of chest wall toxicity after lung stereotactic body radiotherapy.pdf

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Predictors and management of chest wall toxicity after lung stereotactic body radiotherapy

Cancer Treatment Reviews xxx (2014) xxx–xxxContents lists available at ScienceDirect Cancer Treatment Reviews journal homepage: www.elsevierheal / journals /c t rvComplications of TreatmentPredictors and management of chest wall toxicity after lung stereotactic body radiotherapy/10.1016/j.ctrv.2014.09.003 0305-7372/ 2014 Published by Elsevier Ltd. ? Corresponding author at: Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA. Tel.: +1 215 728 2581; fax: +1 215 214 4038. E-mail address: Talha.Shaikh@ (T. Shaikh). Please cite this article in press as: Shaikh T, Turaka A. Predictors and management of chest wall toxicity after lung stereotactic body radiotherapy. Treat Rev (2014), /10.1016/j.ctrv.2014.09.003Talha Shaikh ?, Aruna Turaka Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA a r t i c l e i n f oArticle history: Received 17 June 2014 Received in revised form 19 August 2014 Accepted 7 September 2014 Available online xxxx Keywords: Stereotactic body radiotherapy Lung cancer Chest wall toxicity Rib fracturea b s t r a c t Stereotactic body radiotherapy is the preferred treatment modality for patients with inoperable early stage lung cancer. Chest wall toxicity is a potentially dose limiting side effect and may include fractures or pain secondary to treatment. The pathophysiology of these symptoms is unclear although it is pre- sumed that radiation may alter the bone’s normal tissue environment, affecting maintenance and remod- eling. Chest wall pain is likely neuropathic secondary to injury to the intercostal nerves. Identifying patients with chest wall toxicity can be difficult due to the varying definitions of toxicity as well as het- erogeneous contouring guidelines. Multiple studies have demonstrated a correlation between treatment factors and the incidence of chest wall toxicity. An increase in dose and treatment volume appear to be the most consistent radiation factors as