Chest Wall Toxicity after Stereotactic Radiation in Early Lung Cancer: A Systematic Review

Background: Radiation-induced chest wall pain (CWP) and rib fracture (RF) are late adverse effects after stereotactic body radiation therapy (SBRT) for stage i non-small-cell lung cancer (NSCLC); however, the literature about their incidence and risk factors shows variability. We performed a systematic review to determine the pooled incidence of CWP and RF in the relevant population. Methods: A literature search using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines considered English publications in MEDLINE and EMBASE from January 1996 to August 2017. Abstracts were screened, followed by full-text review and data extraction. Results: The database searches identified 547 records. Twenty-eight publications comprising 3892 patients met the inclusion criteria. Median reported ages and follow-up durations fell into the ranges 67–82 years and 12–84 months. Prescriptions fell into the range of 40–70 Gy in 3–10 fractions. Despite study heterogeneity, the pooled incidences of CWP and RF were estimated to be 8.94% and 5.27% respectively. Nineteen studies reported cwp grade: 58 of 308 patients (18.8%) experienced grades 3–4 CWP (no grade 5 events reported). Thirteen studies reported RF grade: grades 3–4 RF were observed in 9 of 113 patients (7.96%). A high chest wall V30 was an important predictor of CWP and RF. Conclusions: In patients with stage i nsclc, rates of CWP and RF after SBRT are low; however, tumour location, accurate toxicity reporting, and dose–fractionation schemes might alter those rates. Prospective correlation with dosimetry and quality of life assessment will further improve the understanding of CWP and RF after sbrt.