Factors associated with chest wall toxicity after accelerated partial breast irradiation using high-dose-rate brachytherapy

Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):801-5. doi: 10.1016/j.ijrobp.2011.08.033. Epub 2012 Jan 13.

Abstract

Purpose: The purpose of this analysis was to evaluate dose-volume relationships associated with a higher probability for developing chest wall toxicity (pain) after accelerated partial breast irradiation (APBI) by using both single-lumen and multilumen brachytherapy.

Methods and materials: Rib dose data were available for 89 patients treated with APBI and were correlated with the development of chest wall/rib pain at any point after treatment. Ribs were contoured on computed tomography planning scans, and rib dose-volume histograms (DVH) along with histograms for other structures were constructed. Rib DVH data for all patients were sampled at all volumes ≥0.008 cubic centimeter (cc) (for maximum dose related to pain) and at volumes of 0.5, 1, 2, and 3 cc for analysis. Rib pain was evaluated at each follow-up visit. Patient responses were marked as yes or no. No attempt was made to grade responses. Eighty-nine responses were available for this analysis.

Results: Nineteen patients (21.3%) complained of transient chest wall/rib pain at any point in follow-up. Analysis showed a direct correlation between total dose received and volume of rib irradiated with the probability of developing rib/chest wall pain at any point after follow-up. The median maximum dose at volumes ≥0.008 cc of rib in patients who experienced chest wall pain was 132% of the prescribed dose versus 95% of the prescribed dose in those patients who did not experience pain (p = 0.0035).

Conclusions: Although the incidence of chest wall/rib pain is quite low with APBI brachytherapy, attempts should be made to keep the volume of rib irradiated at a minimum and the maximum dose received by the chest wall as low as reasonably achievable.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy / adverse effects*
  • Brachytherapy / methods
  • Chest Pain / etiology*
  • Chest Pain / prevention & control
  • Dose-Response Relationship, Radiation
  • Female
  • Humans
  • Middle Aged
  • Radiotherapy Planning, Computer-Assisted
  • Retrospective Studies
  • Ribs / radiation effects*
  • Thoracic Wall / radiation effects*