Table 6.
Summary of key literature reports on the effect of dose rate and lung dose.
| First author, publication year | N | Prescribed dose (Gy)/fx | Lung dose (Gy) | Dose rate (cGy/min) | Findings |
|---|---|---|---|---|---|
| Barrett, 1982 (80) | 402* | 7.5-10.5/1 | 1-12 | 2.5-46 | Dose rate associated with incidence of PT only for lung dose ≥9 Gy. |
| Bortin, 1982 (95) | 176* | ≥8 | NR | 2.3-30 | Dose rate ≤5.7 cGy/min associated with lower risk of PT 30% vs. 6%) |
| Weiner, 1986 (19) | 932^ | 10/1 or 12/5-6 | 5.6-12.8 | 2-108 | Dose rate significantly correlated with risk of PT only in those receiving MTX after transplantation. |
| Ozsahin, 1996 (43) | 186^ | 10/1 or 12/6 BID | 8 or 9 | 2.6-16.9 | PT incidence was significantly higher in the high dose rate patients – 56% (> 9cGy/min) vs. 20% (≤4.8 cGy/min). |
| Corvo, 1999 (89) | 93^ | 12/6 BID | 10.8 or 12 | 2.5-15 | PT incidence was correlated with higher dose rate – 33% (>6 cGy/min) vs. 12% (<6 cGy/min). |
| Carruthers, 2004 (53) | 84^ | 12/6 | NR | 7.5 and 15 | A higher dose rate associated with a higher risk of PT - 43% (15 cGy/min) vs. 13% (7.5 cGy/min). |
| Abugideiri, 2016 (69) | 129± | 10.5-14 (1.5-2 Gy/fx) | ≤ 10 | 5.6-20.9 | TBI dose rate ≥15 cGy/min significantly increased incidence of PT [HR 4.85] and IPS [HR 4.94]. |
| Kim, 2018 (17) | 92^ | 9-12/3-4 daily | 5-10% attenuation | 4.2-17.3 | Reducing the dose rate decreased the risk of PT - 74.1% (≥6 cGy/min) vs. 43.5% (<6 cGy/min). |
| Gao, 2019 (77) | 202^ | 13.2/8 BID | None | 8.6-19.2 | IPS in 29% (>15cGy/min) vs 10% (≤15cGy/min). |
| Petersen, 1992 (87) | 36^ | 12 or 16/6 BID, 17/7 BID | Prescription | 8 | PT or IPS in 50% of patients receiving 17Gy as compared to 15% after 16Gy. |
| Sampath, 2005 (91) | 1090* | Up to 15.6 | Up to 15.6 | 3-41 | Lung dose was associated with PT in patients receiving 1 fx/day – 2.3% if ≤6 Gy to lungs. |
| Soule, 2007 (57) | 181≠ | 12 or 13.6 (1.5-1.7 Gy/fx bid) | 6 to >13.6 | 12 | Lung dose reduction should be employed primarily to decrease mortality from PT in high-risk patients. |
| Weschler, 1990 (30) | 43^ | 6/4 BID (TLI) or 12/6 BID (TBI) | 6 or 12 | 15-18 | IPS occurred in 26% without lung shielding as compared to 0% with partial lung shielding. |
bid, twice a day; fx, fraction; HR, hazard ratio; IP, interstitial pneumonitis; IPS, idiopathic pneumonia syndrome; MTX, methotrexate; NR, not reported; PT, pulmonary toxicity; TBI, total body irradiation; TLI, total lymphoid irradiation; *ages not specified; ^adults and children; ±children; ≠adults and adolescents.