{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T11:34:30Z","timestamp":1782732870443,"version":"3.54.5"},"reference-count":37,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T00:00:00Z","timestamp":1608681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Objective: To assess the impact of (low) dose irradiation to the lungs and heart on the incidence of pneumonitis and pulmonary function changes after thoracic radiotherapy (RT). Methods\/Material: Data of 62 patients treated with curative thoracic radiotherapy were analyzed. Toxicity data and pulmonary function tests (PFTs) were obtained before RT and at 6 weeks, at 12 weeks, and at 6 months after RT. PFTs included ventilation (e.g., vital capacity) and diffusion parameters (e.g., diffusion capacity for carbon monoxide (DLCO)). Dosimetric data of the lung and heart were extracted to assess the impact of dose on PFT changes and radiation pneumonitis (RP). Results: No statistically significant correlations between dose parameters and changes in ventilation parameters were found. There were statistically significant correlations between DLCO and low-dose parameters of the lungs (V5Gy\u2013V30Gy (%)) and irradiation of the heart during the follow-up up to 6 months after RT, as well as a temporary correlation of the V60Gy (%) on the blood gas parameters at 12 weeks after RT. On multivariate analysis, both heart and lung parameters had a significant impact on DLCO. There was no statistically significant influence of any patient or treatment-related (including dose parameters) factors on the incidence of \u2265G2 pneumonitis. Conclusion: There seems to be a lasting impact of low dose irradiation to the lung as well as irradiation to the heart on the DLCO after thoracic radiotherapy. No influence on RP was found in this analysis.<\/jats:p>","DOI":"10.3390\/cancers13010022","type":"journal-article","created":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T08:38:43Z","timestamp":1608712723000},"page":"22","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of Low-Dose Irradiation of the Lung and Heart on Toxicity and Pulmonary Function Parameters after Thoracic Radiotherapy"],"prefix":"10.3390","volume":"13","author":[{"given":"Christina","family":"Schr\u00f6der","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Ruppiner Kliniken GmbH, Medizinische Hochschule Brandenburg (MHB), Fehrbelliner Strasse 38, 16816 Neuruppin, Germany"},{"name":"Institute of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Brauerstrasse 15, 8401 Winterthur, Switzerland"},{"name":"Center for Proton Therapy, Paul Scherrer Institute (PSI), ETH Domain, Forschungsstrasse 111, 5232 Villigen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Buchali","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ruppiner Kliniken GmbH, Medizinische Hochschule Brandenburg (MHB), Fehrbelliner Strasse 38, 16816 Neuruppin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1040-4888","authenticated-orcid":false,"given":"Paul","family":"Windisch","sequence":"additional","affiliation":[{"name":"Institute of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Brauerstrasse 15, 8401 Winterthur, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3298-517X","authenticated-orcid":false,"given":"Erwin","family":"Vu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Cantonal Hospital St. Gallen (KSSG), Rorschacher Strasse 95, 9007 St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1259-5825","authenticated-orcid":false,"given":"Lucas","family":"Basler","sequence":"additional","affiliation":[{"name":"Center for Proton Therapy, Paul Scherrer Institute (PSI), ETH Domain, Forschungsstrasse 111, 5232 Villigen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4359-7735","authenticated-orcid":false,"given":"Daniel R.","family":"Zwahlen","sequence":"additional","affiliation":[{"name":"Institute of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Brauerstrasse 15, 8401 Winterthur, Switzerland"},{"name":"Medical Faculty, University of Zurich (UZH), Pestalozzistrasse 3\/5, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7664-9207","authenticated-orcid":false,"given":"Robert","family":"F\u00f6rster","sequence":"additional","affiliation":[{"name":"Institute of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Brauerstrasse 15, 8401 Winterthur, Switzerland"},{"name":"Medical Faculty, University of Zurich (UZH), Pestalozzistrasse 3\/5, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.ijrobp.2004.11.029","article-title":"Pulmonary function changes after radiotherapy in non\u2013small-cell lung cancer patients with long-term disease-free survival","volume":"62","author":"Borst","year":"2005","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/0360-3016(94)00513-3","article-title":"The effect of irradiation on lung function and perfusion in patients with lung cancer","volume":"31","author":"Abratt","year":"1995","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/S0360-3016(03)00182-2","article-title":"Long-term changes in pulmonary function tests after definitive radiotherapy for lung cancer","volume":"56","author":"Miller","year":"2003","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.ijrobp.2013.12.050","article-title":"No clinically significant changes in pulmonary function following stereotactic body radiation therapy for early- stage peripheral non-small cell lung cancer: An analysis of RTOG 0236","volume":"88","author":"Stanic","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e565","DOI":"10.1016\/j.ijrobp.2012.07.003","article-title":"Long-term Changes in Pulmonary Function After Incidental Lung Irradiation for Breast Cancer: A Prospective Study With 7-Year Follow-up","volume":"84","author":"Jaen","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1200\/JCO.2001.19.2.543","article-title":"Can we predict radiation-induced changes in pulmonary function based on the sum of predicted regional dysfunction?","volume":"19","author":"Fan","year":"2001","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ijrobp.2005.03.047","article-title":"Radiation pneumonitis and pulmonary fibrosis in non-small-cell lung cancer: Pulmonary function, prediction, and prevention","volume":"63","author":"Mehta","year":"2005","journal-title":"Radiat. Oncol. Biol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1016\/j.ijrobp.2007.08.050","article-title":"Pulmonary Changes After Radiotherapy for Conservative Treatment of Breast Cancer: A Prospective Study","volume":"70","author":"Krengli","year":"2008","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e537","DOI":"10.1016\/j.ijrobp.2012.01.019","article-title":"Changes in Pulmonary Function After Three-Dimensional Conformal Radiotherapy, Intensity-Modulated Radiotherapy, or Proton Beam Therapyfor Non-Small-Cell Lung Cancer","volume":"83","author":"Gomez","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/S0360-3016(02)04389-4","article-title":"Pulmonary function following high-dose radiotherapy of non\u2013small-cell lung cancer","volume":"55","author":"Seppenwoolde","year":"2003","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/S0169-5002(01)00334-8","article-title":"Lung toxicity following chest irradiation in patients with lung cancer","volume":"35","author":"Abratt","year":"2002","journal-title":"Lung. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.ijrobp.2010.12.058","article-title":"Changes in Pulmonary Function up to 10 Years after Locoregional Breast Irradiation","volume":"82","author":"Erven","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s00066-016-1067-8","article-title":"Changes in pulmonary function and influencing factors after high-dose intrathoracic radio(chemo)therapy","volume":"193","author":"Vorwerk","year":"2017","journal-title":"Strahlenther. Onkol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1097\/00130404-200211000-00009","article-title":"Effect of concurrent radiation therapy and chemotherapy on pulmonary function in patients with esophageal cancer: Dose-volume histogram analysis","volume":"8","author":"Gergel","year":"2002","journal-title":"Cancer J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"34","DOI":"10.3857\/roj.2013.31.1.34","article-title":"Predictors of radiation pneumonitis and pulmonary function changes after concurrent chemoradiotherapy of non-small cell lung cancer","volume":"31","author":"Park","year":"2013","journal-title":"Radiat. Oncol. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1159\/000342371","article-title":"Impact of 3D conformal radiotherapy on lung function of patients with lung cancer: A prospective study","volume":"86","author":"Enache","year":"2013","journal-title":"Respiration"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/S0360-3016(02)04288-8","article-title":"Do dose\u2013volume metrics predict pulmonary function changes in lung irradiation?","volume":"55","author":"Allen","year":"2003","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/S0360-3016(03)00077-4","article-title":"Effects of radiotherapy and chemotherapy on lung function in patients with non\u2013small-cell lung cancer","volume":"56","author":"Gopal","year":"2003","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1016\/j.ijrobp.2009.06.075","article-title":"Toxicity and outcome results of a class solution with moderately hypofractionated radiotherapy in inoperable Stage III non-small cell lung cancer using helical tomotherapy","volume":"77","author":"Bral","year":"2010","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1016\/j.ijrobp.2006.03.008","article-title":"Changes in pulmonary function after incidental lung irradiation for breast cancer: A prospective study","volume":"65","author":"Jaen","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S70","DOI":"10.1016\/j.ijrobp.2009.06.091","article-title":"Radiation dose\u2013volume effects in the lung","volume":"76","author":"Marks","year":"2010","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/0360-3016(91)90171-Y","article-title":"Tolerance of normal tissue to therapeutic irradiation","volume":"21","author":"Emami","year":"1991","journal-title":"Radiat. Oncol. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/S0360-3016(99)00183-2","article-title":"Clinical dose\u2013volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC)","volume":"45","author":"Graham","year":"1999","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/S0360-3016(01)01685-6","article-title":"Radiation-induced pulmonary toxicity: A dose-volume histogram analysis in 201 patients with lung cancer","volume":"51","author":"Hernando","year":"2001","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.ijrobp.2006.01.051","article-title":"Final toxicity results of a radiation-dose escalation study in patients with non\u2013small-cell lung cancer (NSCLC): Predictors for radiation pneumonitis and fibrosis","volume":"65","author":"Kong","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S0167-8140(03)00119-1","article-title":"Factors predicting radiation pneumonitis in lung cancer patients: A retrospective study","volume":"67","author":"Rancati","year":"2003","journal-title":"Radiother. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0360-3016(00)00648-9","article-title":"Factors predicting severe radiation pneumonitis in patients receiving definitive chemoradiation for lung cancer","volume":"48","author":"Robnett","year":"2000","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s00066-010-2018-4","article-title":"Korrelation von patientenbezogenen Faktoren und Dosis-Volumen-Histogramm-Parametern mit dem Auftreten einer radiogenen Pneumonitis bei Patienten mit kleinzelligem Bronchialkarzinom","volume":"186","author":"Roeder","year":"2010","journal-title":"Strahlenther. Onkol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/BF03038240","article-title":"Pneumonitis nach Strahlentherapie des Bronchialkarzinoms \u2014 Inzidenz und Einflu\u00dffaktoren","volume":"173","author":"Schraube","year":"1997","journal-title":"Strahlenther. Onkol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1007\/s00066-003-1078-0","article-title":"Dosis-Volumen-Histogramm-Analyse zum Pneumonitisrisiko bei 3-D-konformaler Strahlentherapie im Bereich der Lunge","volume":"179","author":"Willner","year":"2003","journal-title":"Strahlenther. Onkol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1093\/jrr\/rrv057","article-title":"Association between absolute volumes of lung spared from low-dose irradiation and radiation-induced lung injury after intensity-modulated radiotherapy in lung cancer: A retrospective analysis","volume":"56","author":"Chen","year":"2015","journal-title":"J. Radiat. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.radonc.2019.01.003","article-title":"Predicting radiation pneumonitis in locally advanced stage II-III non-small cell lung cancer using machine learning","volume":"133","author":"Luna","year":"2019","journal-title":"Radiother. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s13014-019-1283-3","article-title":"Prognostic significance of lung radiation dose in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy","volume":"14","author":"Lin","year":"2019","journal-title":"Radiat. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e107","DOI":"10.1016\/j.ijrobp.2011.01.037","article-title":"Pulmonary Function Testing After Stereotactic Body Radiotherapy to the Lung","volume":"82","author":"Bishawi","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/S0360-3016(97)00343-X","article-title":"Physical and biological predictors of changes in whole-lung function following thoracic irradiation","volume":"39","author":"Marks","year":"1997","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"51","DOI":"10.3109\/0284186X.2010.521192","article-title":"Heart irradiation as a risk factor for radiation pneumonitis","volume":"50","author":"Huang","year":"2011","journal-title":"Acta Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"590","DOI":"10.3109\/0284186X.2013.831185","article-title":"Is there an impact of heart exposure on the incidence of radiation pneumonitis? Analysis of data from a large clinical cohort","volume":"53","author":"Tucker","year":"2014","journal-title":"Acta Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/1\/22\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:48:40Z","timestamp":1760179720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/1\/22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,23]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1]]}},"alternative-id":["cancers13010022"],"URL":"https:\/\/doi.org\/10.3390\/cancers13010022","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,23]]}}}