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Keshavamurthy KN, Eickhoff C, Ziv E. Pre-operative lung ablation prediction using deep learning. Eur Radiol 2024:10.1007/s00330-024-10767-8. [PMID: 38775950 DOI: 10.1007/s00330-024-10767-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 02/09/2024] [Accepted: 03/07/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Microwave lung ablation (MWA) is a minimally invasive and inexpensive alternative cancer treatment for patients who are not candidates for surgery/radiotherapy. However, a major challenge for MWA is its relatively high tumor recurrence rates, due to incomplete treatment as a result of inaccurate planning. We introduce a patient-specific, deep-learning model to accurately predict post-treatment ablation zones to aid planning and enable effective treatments. MATERIALS AND METHODS Our IRB-approved retrospective study consisted of ablations with a single applicator/burn/vendor between 01/2015 and 01/2019. The input data included pre-procedure computerized tomography (CT), ablation power/time, and applicator position. The ground truth ablation zone was segmented from follow-up CT post-treatment. Novel deformable image registration optimized for ablation scans and an applicator-centric co-ordinate system for data analysis were applied. Our prediction model was based on the U-net architecture. The registrations were evaluated using target registration error (TRE) and predictions using Bland-Altman plots, Dice co-efficient, precision, and recall, compared against the applicator vendor's estimates. RESULTS The data included 113 unique ablations from 72 patients (median age 57, interquartile range (IQR) (49-67); 41 women). We obtained a TRE ≤ 2 mm on 52 ablations. Our prediction had no bias from ground truth ablation volumes (p = 0.169) unlike the vendor's estimate (p < 0.001) and had smaller limits of agreement (p < 0.001). An 11% improvement was achieved in the Dice score. The ability to account for patient-specific in-vivo anatomical effects due to vessels, chest wall, heart, lung boundaries, and fissures was shown. CONCLUSIONS We demonstrated a patient-specific deep-learning model to predict the ablation treatment effect prior to the procedure, with the potential for improved planning, achieving complete treatments, and reduce tumor recurrence. CLINICAL RELEVANCE STATEMENT Our method addresses the current lack of reliable tools to estimate ablation extents, required for ensuring successful ablation treatments. The potential clinical implications include improved treatment planning, ensuring complete treatments, and reducing tumor recurrence.
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Affiliation(s)
| | - Carsten Eickhoff
- University of Tübingen Geschwister-Scholl-Platz, 72074, Tübingen, Germany
| | - Etay Ziv
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Kamtam DN, Binkley MS, Kapula N, Sadeghi C, Nesbit S, Guo HH, Chang J, Maxim PG, Diehn M, Loo BW, Shrager JB. First in Human Phase 1 Clinical Trial of Stereotactic Irradiation to Achieve Lung Volume Reduction (SILVR) in Severe Emphysema. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00479-6. [PMID: 38615887 DOI: 10.1016/j.ijrobp.2024.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/14/2024] [Accepted: 03/30/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Only a subset of patients with severe emphysema qualify for lung volume reduction surgery or endobronchial valves. We previously demonstrated that stereotactic ablative radiation therapy of lung tumors reduces lung volume in treated lobes by creating localized lung fibrosis. We aimed to determine the safety and secondarily explore the efficacy of stereotactic irradiation for lung volume reduction (SILVR) over 18 months after intervention in patients with severe emphysema. METHODS AND MATERIALS We conducted a single-arm, prospective clinical trial in eligible patients with severe emphysema treated with unilateral stereotactic ablative radiation therapy (45 Gy in 3 fractions) to a target within the most emphysematous region. The primary outcome was safety in terms of incidence of grade ≥3 adverse events, and the secondary outcome was efficacy. RESULTS Eight patients received the intervention. Median (range) baseline characteristics were age 73 years (63-78); forced expiratory volume in 1 second percent of predicted value (FEV1%) 28.5% (19.0-42.0); diffusing capacity of the lungs for carbon monoxide percent of predicted value 40% (24.0-67.0); and body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index 5.5 (5-9). The incidence of grade ≥3 adverse events was 3 of 8 (37.5%). The relative change in target lobe volume was -23.1% (-1.6 to -41.5) and -26.5% (-20.6 to -40.8) at 6 and 18 months, respectively. The absolute ΔFEV1% was greater in patients with a BODE index ≤5 versus ≥6 (+12.0% vs -2.0%). The mean baseline lung density (in Hounsfield units, reflecting the amount of preserved parenchyma) within the intermediate dose volume (V60BED3) correlated with the absolute change in target lobe volume at 18 months. CONCLUSIONS SILVR appears to be safe, with a signal for efficacy as a novel therapeutic alternative for patients with severe emphysema. SILVR may be most safe and effective in patients with a lower BODE index and/or less parenchymal destruction.
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Affiliation(s)
- Devanish N Kamtam
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael S Binkley
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Ntemena Kapula
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Cheyenne Sadeghi
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Shannon Nesbit
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Haiwei Henry Guo
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Joon Chang
- Division of Pulmonary Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Peter G Maxim
- Department of Radiation Oncology, University of California Irvine School of Medicine, Irvine, California
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
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Bensenane R, Helfre S, Cao K, Carton M, Champion L, Girard N, Glorion M, Vieira T, Waissi W, Crehange G, Beddok A. Optimizing lung cancer radiation therapy: A systematic review of multifactorial risk assessment for radiation-induced lung toxicity. Cancer Treat Rev 2024; 124:102684. [PMID: 38278078 DOI: 10.1016/j.ctrv.2024.102684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Radiation therapy (RT) is essential in treating advanced lung cancer, but may lead to radiation pneumonitis (RP). This systematic review investigates the use of pulmonary function tests (PFT) and other parameters to predict and mitigate RP, thereby improving RT planning. METHODS A systematic review sifted through PubMed and on BioMed Central, targeting articles from September 2005 to December 2022 containing the keywords: Lung Cancer, Radiotherapy, and pulmonary function test. RESULTS From 1153 articles, 80 were included. RP was assessed using CTCAEv.4 in 30 % of these. Six studies evaluated post-RT quality of life in lung cancer patients, reporting no decline. Patients with RP and chronic obstructive pulmonary disease (COPD) generally exhibited poorer overall survival. Notably, forced expiratory volume in one second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) declined 24 months post-RT, while forced vital capacity (FVC) stayed stable. In the majority of studies, age over 60, tumors located in the lower part of the lung, and low FEV1 before RT were associated with a higher risk of RP. Dosimetric factors (V5, V20, MLD) and metabolic imaging emerged as significant predictors of RP risk. A clinical checklist blending patient and tumor characteristics, PFT results, and dosimetric criteria was proposed for assessing RP risk before RT. CONCLUSION The review reveals the multifactorial nature of RP development following RT in lung cancer. This approach should guide individualized management and calls for a prospective study to validate these findings and enhance RP prevention strategies.
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Affiliation(s)
- Rayan Bensenane
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Sylvie Helfre
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Kim Cao
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | | | | | - Nicolas Girard
- Institut Curie, Department of Thoracic Oncology, Paris, France
| | | | - Thibaut Vieira
- Institut Mutualist Montsouris, Department of Pneumology, Paris, France
| | - Waisse Waissi
- Centre Léon Bérard, Department of Radiation Oncology, Lyon, France
| | - Gilles Crehange
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Arnaud Beddok
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France; Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898 Orsay, France.
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Bucknell NW, Kron T, Herschtal A, Hardcastle N, Irving L, MacManus M, Hanna GG, Moore A, Murnane A, Siva S, Ball D. Comparison of Changes in Pulmonary Function After Stereotactic Body Radiation Therapy Versus Conventional 3-Dimensional Conformal Radiation Therapy for Stage I and IIA Non-Small Cell Lung Cancer: An Analysis of the TROG 09.02 (CHISEL) Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 117:378-386. [PMID: 37087060 DOI: 10.1016/j.ijrobp.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE The TROG 09.02 CHISEL trial compared conventional radiation therapy (CRT) with stereotactic body radiation therapy (SBRT) in patients with inoperable early-stage non-small cell lung cancer. Patients randomized to SBRT had less local failure and improved overall survival. This analysis reports differences in pulmonary function tests (PFTs) and the 6-minute walk test (SMWT) between patients who received SBRT and those who received CRT. METHODS AND MATERIALS We analyzed the PFTs and SMWTs of all patients recruited to the CHISEL [trial. During this trial, patients underwent serial PFTs. Linear regression models were used to compare parameters between SBRT and CRT at 3 and 12 months after treatment. RESULTS One hundred and one patients were enrolled; 33 patients were treated with CRT, 61 were treated with SBRT, and 7 did not receive treatment. Primary tumor size was similar between arms: SBRT 25 mm (standard deviation [SD], 9) and CRT 28 mm (SD, 9). On regression analysis, at 3 and 12 months, there was no evidence of a difference between arms in PFT decline or distance walked in the SMWT. Planning target volume size was significantly larger in the CRT arm, 142.79 cc (SD, 61.14), compared with the SBRT group, 46.15 cc (SD, 23.39). The mean biologically effective dose received by the target was significantly larger in the SBRT group, 125.92 Gy (SD, 21.58), compared with CRT, 65.49 Gy (SD, 6.32). Mean dose to the lungs minus the gross target volume incorporating motion was 8.9 Gy (SD, 2.34) in the CRT group and 4.37 Gy (SD, 1.42) in the SBRT group. CONCLUSIONS Despite the considerably higher biologically effective doses delivered to the tumor in SBRT, there was no difference in decline in respiratory function observed between the 2 groups.
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Affiliation(s)
- Nicholas W Bucknell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nicholas Hardcastle
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Alisha Moore
- TROG Cancer Research, Waratah, New South Wales, Australia
| | - Andrew Murnane
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Dong Y, Kumar H, Tawhai M, Veiga C, Szmul A, Landau D, McClelland J, Lao L, Burrowes KS. In Silico Ventilation Within the Dose-Volume is Predictive of Lung Function Post-radiation Therapy in Patients with Lung Cancer. Ann Biomed Eng 2020; 49:1416-1431. [PMID: 33258090 PMCID: PMC8058012 DOI: 10.1007/s10439-020-02697-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022]
Abstract
Lung cancer is a leading cause of death worldwide. Radiation therapy (RT) is one method to treat this disease. A common side effect of RT for lung cancer is radiation-induced lung damage (RILD) which leads to loss of lung function. RILD often compounds pre-existing smoking-related regional lung function impairment. It is difficult to predict patient outcomes due to large variability in individual response to RT. In this study, the capability of image-based modelling of regional ventilation in lung cancer patients to predict lung function post-RT was investigated. Twenty-five patient-based models were created using CT images to define the airway geometry, size and location of tumour, and distribution of emphysema. Simulated ventilation within the 20 Gy isodose volume showed a statistically significant negative correlation with the change in forced expiratory volume in 1 s 12-months post-RT (p = 0.001, R = - 0.61). Patients with higher simulated ventilation within the 20 Gy isodose volume had a greater loss in lung function post-RT and vice versa. This relationship was only evident with the combined impact of tumour and emphysema, with the location of the emphysema relative to the dose-volume being important. Our results suggest that model-based ventilation measures can be used in the prediction of patient lung function post-RT.
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Affiliation(s)
- Yu Dong
- Department of Chemical and Materials Engineering, University of Auckland, Auckland, New Zealand
| | - H Kumar
- Auckland Bioengineering Institute, Level 6, 70 Symonds Street, Auckland, 1010, New Zealand
| | - M Tawhai
- Auckland Bioengineering Institute, Level 6, 70 Symonds Street, Auckland, 1010, New Zealand
| | - C Veiga
- Centre for Medical Image Computing, Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - A Szmul
- Centre for Medical Image Computing, Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - D Landau
- Department of Oncology, University College London Hospital, London, UK
| | - J McClelland
- Centre for Medical Image Computing, Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - L Lao
- Auckland District Health Board, Auckland, New Zealand
| | - K S Burrowes
- Department of Chemical and Materials Engineering, University of Auckland, Auckland, New Zealand. .,Auckland Bioengineering Institute, Level 6, 70 Symonds Street, Auckland, 1010, New Zealand.
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Roesch J, Cho JB, Fahim DK, Gerszten PC, Flickinger JC, Grills IS, Jawad M, Kersh R, Letourneau D, Mantel F, Sahgal A, Shin JH, Winey B, Guckenberger M. Risk for surgical complications after previous stereotactic body radiotherapy of the spine. Radiat Oncol 2017; 12:153. [PMID: 28893299 PMCID: PMC5594477 DOI: 10.1186/s13014-017-0887-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/05/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECT Stereotactic body radiotherapy (SBRT) for vertebral metastases has emerged as a promising technique, offering high rates of symptom relief and local control combined with low risk of toxicity. Nonetheless, local failure or vertebral instability may occur after spine SBRT, generating the need for subsequent surgery in the irradiated region. This study evaluated whether there is an increased incidence of surgical complications in patients previously treated with SBRT at the index level. METHODS Based upon a retrospective international database of 704 cases treated with SBRT for vertebral metastases, 30 patients treated at 6 different institutions were identified who underwent surgery in a region previously treated with SBRT. RESULTS Thirty patients, median age 59 years (range 27-84 years) underwent SBRT for 32 vertebral metastases followed by surgery at the same vertebra. Median follow-up time from SBRT was 17 months. In 17 cases, conventional radiotherapy had been delivered prior to SBRT at a median dose of 30 Gy in median 10 fractions. SBRT was administered with a median prescription dose of 19.3 Gy (range 15-65 Gy) delivered in median 1 fraction (range 1-17) (median EQD2/10 = 44 Gy). The median time interval between SBRT and surgical salvage therapy was 6 months (range 1-39 months). Reasons for subsequent surgery were pain (n = 28), neurological deterioration (n = 15) or fracture of the vertebral body (n = 13). Open surgical decompression (n = 24) and/or stabilization (n = 18) were most frequently performed; Five patients (6 vertebrae) were treated without complications with vertebroplasty only. Increased fibrosis complicating the surgical procedure was explicitly stated in one surgical report. Two durotomies occurred which were closed during the operation, associated with a neurological deficit in one patient. Median blood loss was 500 ml, but five patients had a blood loss of more than 1 l during the procedure. Delayed wound healing was reported in two cases. One patient died within 30 days of the operation. CONCLUSION In this series of surgical interventions following spine SBRT, the overall complication rate was 19%, which appears comparable to primary surgery without previous SBRT. Prior spine SBRT does not appear to significantly increase the risk of intra- and post-surgical complications.
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Affiliation(s)
- Johannes Roesch
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - John B.C. Cho
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada
| | - Daniel K. Fahim
- Department of Neurosurgery, William Beaumont Hospital, Royal Oak, Michigan USA
| | - Peter C. Gerszten
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA
| | - John C. Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA
| | - Inga S. Grills
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan USA
| | - Maha Jawad
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan USA
| | - Ronald Kersh
- Department of Radiation Oncology, Riverside Medical Center, Newport News, Virginia USA
| | - Daniel Letourneau
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada
| | - Frederick Mantel
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Brian Winey
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts USA
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Binkley MS, King MT, Shrager JB, Bush K, Chaudhuri AA, Popat R, Gensheimer MF, Maxim PG, Henry Guo H, Diehn M, Nair VS, Loo BW. Pulmonary function after lung tumor stereotactic ablative radiotherapy depends on regional ventilation within irradiated lung. Radiother Oncol 2017; 123:270-275. [PMID: 28460826 DOI: 10.1016/j.radonc.2017.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/07/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine if regional ventilation within irradiated lung volume predicts change in pulmonary function test (PFT) measurements after stereotactic ablative radiotherapy (SABR) of lung tumors. METHODS We retrospectively identified 27 patients treated from 2007 to 2014 at our institution who received: (1) SABR without prior thoracic radiation; (2) pre-treatment 4-dimensional computed tomography (4-D CT) imaging; (3) pre- and post-SABR PFTs <15months from treatment. We defined the ventilation ratio (VR20BED3) as the quotient of mean ventilation (mean Jacobian-based per-voxel volume change on deformably registered inhale/exhale 4-D CT phases) within the 20Gy biologically effective dose (α/β=3Gy) isodose volume and that of the total lung volume (TLV). RESULTS Most patients had moderate to very severe COPD by GOLD criteria (n=19, 70.1%). Higher VR20BED3 significantly predicted worse change in Forced Expiratory Volume/s normalized by baseline value (ΔFEV1/FEV1pre, p=0.04); n=7 had VR20BED3>1 (high regional ventilation) and worse ΔFEV1/FEV1pre (median=-0.16, range=-0.230 to -0.20). Five had VR20BED3<1 (low regional ventilation) and improved ΔFEV1/FEV1pre (median=0.13, range=0.07 to 0.20). In a multivariable linear model, increasing VR20BED3 and time to post-SABR PFT predicted decreasing ΔFEV1/FEV1pre (R2=0.25, p=0.03). CONCLUSIONS After SABR to high versus low functioning lung regions, we found worsened or improved global pulmonary function, respectively. If pre-SABR VR20BED3 is validated as a predictor of eventual post-SABR PFT in larger studies, it may be used for individualized treatment planning to preserve or even improve pulmonary function after SABR.
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Affiliation(s)
- Michael S Binkley
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Martin T King
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Joseph B Shrager
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - Karl Bush
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Aadel A Chaudhuri
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Rita Popat
- Department of Health Research & Policy, Stanford University School of Medicine, United States
| | - Michael F Gensheimer
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Peter G Maxim
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - H Henry Guo
- Department of Radiology, Stanford University School of Medicine, United States
| | - Maximilian Diehn
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Institute for Stem Cell Biology & Regenerative Medicine, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - Viswam S Nair
- Department of Radiology, Stanford University School of Medicine, United States; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford Cancer Institute and Department of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States.
| | - Billy W Loo
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States.
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