Clinical Research Papers:

Dosimetric factors and Lyman normal-tissue complication modelling analysis for predicting radiation-induced lung injury in postoperative breast cancer radiotherapy: a prospective study

Zhi-Rui Zhou, Qing Han, Shi-Xiong Liang _, Xiao-Dong He, Nu-Yun Cao and Ying-Jie Zi

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Oncotarget. 2017; 8:33855-33863. https://doi.org/10.18632/oncotarget.12979

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Zhi-Rui Zhou1,2,3,*, Qing Han3,*, Shi-Xiong Liang3,4, Xiao-Dong He4, Nu-Yun Cao5 and Ying-Jie Zi3

1 Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, P.R.China

2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R.China

3 Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, P.R.China

4 Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R.China

5 College of Mathematics and Information Science, Guangxi University, Nanning, P.R.China

* These authors have contributed equally to this paper

Correspondence to:

Shi-Xiong Liang, email:

Keywords: intensity modulated radiotherapy; normal tissue complication probability; radiation-induced lung injury; breast cancer

Received: September 16, 2016 Accepted: October 24, 2016 Published: October 28, 2016


To investigate the relationship between dosimetric factors, including Lyman normal-tissue complication (NTCP) parameters and radiation-induced lung injury (RILI), in postoperative breast cancer patients treated by intensity modulated radiotherapy (IMRT). 109 breast cancer patients who received IMRT between January 2012 and December 2013 were prospectively enrolled. A maximum likelihood analysis yielded the best estimates for Lyman NTCP parameters. Ten patients were diagnosed with RILI (primarily Grade 1 or Grade 2 RILI); the rate of RILI was 9.17% (10/109). Multivariate analysis demonstrated that ipsilateral lung V20 was an independent predictor (P=0.001) of RILI. Setting V20=29.03% as the cut-off value, the prediction of RILI achieved high accuracy (94.5%), with a sensitivity of 80% and specificity of 96%. The NTCP model parameters for 109 patients were m=0.437, n=0.912, and TD50(1)=17.211 Gy. The sensitivity of the modified Lyman NTCP model to predict the RILI was 90% (9/10), the specificity was 69.7% (69/99), and the accuracy was 71.6% (78/109). The RILI rate of the NTCP<9.62% in breast cancer patients was 1.43% (1/70), but the RILI rate of the NTCP>9.62% in patients with breast cancer was 23.08% (9/39), (P=0.001). In conclusion, V20 is an independent predictive factor for RILI in patients with breast cancer treated by IMRT; V20=29.03% could be a useful dosimetric parameter to predict the risk of RILI. The Lyman NTCP model parameters of the new value (m=0.437, n=0.912, TD50 (1) =17.211 Gy) can be used as an effective biological index to evaluate the risk of RILI.

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