Daily dose to organs at risk predicts acute toxicity in pancreatic stereotactic radiotherapy

Figures & data

Figure 1. Dot chart summarizing relevant dose parameters for toxicity. Each patient is represented by a white dot; bar represent the value associated with Youden J. (A) Daily D2 to duodenum in patients with with (right) or without (left) acute nausea. (B) Daily D10 to stomach in patients with (right) or without (left) abdominal pain. (C) Daily D10 to bowel in patients with (right) or without (left) acute diarrhea.

Table 1. Median comparison (Kruskall–Wallis Test) for selected parameters between patients with or without acute toxicity following SBRT.

Duodenum		Acute nausea (median [IQR])	No acute nausea (median [IQR])	p
Planned	V35	0.1 [0.0–0.30] cc	0.0 [0.0–0.20] cc	.07
	D2	32.6 [31.9–33.9] Gy	26.7 [19.2–31.5] Gy	.021
	D5	30.5 [29.4–32.8] Gy	21.4 [16.5–29.3] Gy	.021
	D10	26.4 [25.5–30.6] Gy	18.8 [12.1–26.3] Gy	.009
	Dmax	36.4 [36.1–37.6] Gy	35.8 [33.1–37.1] Gy	.045
Daily	V35	0.9 [0.7–1.5] cc	0.3 [0.1–1.1] cc	.025
	D2	33.5 [33.1–34.2] Gy	28.7 [23.8–32.5] Gy	.007
	D5	31.0 [29.5–33.0] Gy	24.3 [19.5–30.7] Gy	.008
	D10	27.1 [24.5–31.1] Gy	19.9 [15.3–27.4] Gy	.014
	Dmax	41.3 [39.8–41.9] Gy	38.5 [36.4–41.9] Gy	.08
Peak	V35	1.4 [1–2.3] cc	0.4 [0.1–2.1] cc	.04
	D2	34.5 [33.8–36.0] Gy	31.7 [24.6–35.3] Gy	.04
	D5	32.3 [31.2–34.5] Gy	25.2 [20.6–31] Gy	.005
	D10	28.7 [26.5–31.5] Gy	20.9 [16.7–28.5] Gy	.01
	Dmax	42.1 [41.7–46.1] Gy	41.9 [38.5–45.5] Gy	.3
Stomach		Acute pain (median [IQR])	No acute pain (median [IQR])	p
Planned	V35	0.1 [0.0–0.4] cc	0.0 [0.0–0.2] cc	.11
	D2	31.9 [27.3–32.9] Gy	25.8 [15.6–32.3] Gy	.06
	D5	29.3 [24.6–30.9] Gy	20.5 [14.0–29.6] Gy	.023
	D10	25.6 [20.1–29] Gy	16.3 [12.9–25.1]Gy	.012
	Dmax	36.8 [35.2–38.4] Gy	35.7 [26–36.8] Gy	.029
Daily	V35	0.3 [0.0–0.9] cc	0.7 [0.2–2.1] cc	.17
	D2	32.5 [28.5–35] Gy	27.9 [18.9–32.8] Gy	.016
	D5	29.0 [25.2–31.7] Gy	22.7 [16.6–29] Gy	.012
	D10	26.0 [21.1–28.5] Gy	18.7 [14.8–23.6] Gy	.005
	Dmax	39.1 [30.4–40.5] Gy	38.3 [36.6–42.3] Gy	.40
Peak	V35	1.8 [0.4–3.2] cc	0.6 [0.0–1.4] cc	.08
	D2	34.7 [29.4–36.5] Gy	31.0 [20.9–34.5] Gy	.034
	D5	32.1 [25.7–33.4]Gy	26.2 [17.3–31.1] Gy	.01
	D10	28.9 [22.3–30.9]Gy	20.9 [15.4–25.8] Gy	.05
	Dmax	41.4 [37.0–45.9] Gy	41.2 [33.3–43.7]Gy	.32
Bowel		Acute diarrhea (median [IQR])	No acute diarrhea (median [IQR])	p
Planned	V35	0.0 [0.0–0.0] cc	0.0 [0.0–0.1] cc	.21
	D2	28.0 [22.7–31.2] Gy	18.8 [13.5–27.5] Gy	.09
	D5	25.2 [21.3–27.9] Gy	16.7 [11.8–23.1] Gy	.07
	D10	23.1 [20.0–24.9] Gy	15.1 [9.7–20.6] Gy	.034
	Dmax	35.3 [32.1–37.4] Gy	31.1 [20.9–36.2] Gy	.23
Daily	V35	0.7 [0.1–1.5] cc	0.0 [0.0–0.2] cc	.13
	D2	29.8 [24.3–32.6] Gy	16.9 [14.9–26.2] Gy	.07
	D5	27.0 [22.3–29.5] Gy	19.0[12.5–22.2] Gy	.038
	D10	24.2 [20.4–26.4] Gy	14.6 [9.8–19.3] Gy	.027
	Dmax	36.6 [31.4–39.9] Gy	32.1 [22.2–38.7] Gy	.22
Peak	V35	1.2 [0.3–3.4] cc	0.0 [0.0–0.6] cc	.12
	D2	33.5 [26.8–37.6] Gy	22.7 [16.8–28.8] Gy	.07
	D5	18.8 [13.1–24.2] Gy	30.7 [24.2–33.8] Gy	.043
	D10	16.5 [10.9–21.1] Gy	27.3 [21.6–29.7] Gy	.031
	Dmax	41.8 [35.0–45.0] Gy	35.9 [27.2–43.1] Gy	.35

For extended analysis refer to Supplementary Table 2s. IQR: inter-quartile range.

Values reaching statistical significance (p < 0.05) are indicated in bold.