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Midroni J, Salunkhe R, Liu Z, Chow R, Boldt G, Palma D, Hoover D, Vinogradskiy Y, Raman S. Incorporation of Functional Lung Imaging Into Radiation Therapy Planning in Patients With Lung Cancer: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00481-4. [PMID: 38631538 DOI: 10.1016/j.ijrobp.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
Our purpose was to provide an understanding of current functional lung imaging (FLI) techniques and their potential to improve dosimetry and outcomes for patients with lung cancer receiving radiation therapy (RT). Excerpta Medica dataBASE (EMBASE), PubMed, and Cochrane Library were searched from 1990 until April 2023. Articles were included if they reported on FLI in one of: techniques, incorporation into RT planning for lung cancer, or quantification of RT-related outcomes for patients with lung cancer. Studies involving all RT modalities, including stereotactic body RT and particle therapy, were included. Meta-analyses were conducted to investigate differences in dose-function parameters between anatomic and functional RT planning techniques, as well as to investigate correlations of dose-function parameters with grade 2+ radiation pneumonitis (RP). One hundred seventy-eight studies were included in the narrative synthesis. We report on FLI modalities, dose-response quantification, functional lung (FL) definitions, FL avoidance techniques, and correlations between FL irradiation and toxicity. Meta-analysis results show that FL avoidance planning gives statistically significant absolute reductions of 3.22% to the fraction of well-ventilated lung receiving 20 Gy or more, 3.52% to the fraction of well-perfused lung receiving 20 Gy or more, 1.3 Gy to the mean dose to the well-ventilated lung, and 2.41 Gy to the mean dose to the well-perfused lung. Increases in the threshold value for defining FL are associated with decreases in functional parameters. For intensity modulated RT and volumetric modulated arc therapy, avoidance planning results in a 13% rate of grade 2+ RP, which is reduced compared with results from conventional planning cohorts. A trend of increased predictive ability for grade 2+ RP was seen in models using FL information but was not statistically significant. FLI shows promise as a method to spare FL during thoracic RT, but interventional trials related to FL avoidance planning are sparse. Such trials are critical to understanding the effect of FL avoidance planning on toxicity reduction and patient outcomes.
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Affiliation(s)
- Julie Midroni
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Canada
| | - Rohan Salunkhe
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Zhihui Liu
- Biostatistics, Princess Margaret Cancer Center, Toronto, Canada
| | - Ronald Chow
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Canada; London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Gabriel Boldt
- London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - David Palma
- London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada; Ontario Institute for Cancer Research, Toronto, Canada
| | - Douglas Hoover
- London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, United States of America; Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, United States of America
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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Li Q, Hu C, Su S, Ma Z, Geng Y, Hu Y, Li H, Lu B. Non-Small Cell Lung Cancer with Malignant Pleural Effusion May Require Primary Tumor Radiotherapy in Addition to Drug Treatment. Cancer Manag Res 2022; 14:3347-3358. [PMID: 36465711 PMCID: PMC9716933 DOI: 10.2147/cmar.s385818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/15/2022] [Indexed: 09/01/2023] Open
Abstract
PURPOSE The impact of primary tumour radiotherapy on the prognosis for non-small-cell lung cancer (NSCLC) with controlled malignant pleural effusion (MPE-C) (MPE-C-NSCLC) is unclear. This study aimed to analyze the efficacy and safety of primary tumor radiotherapy in patients with MPE-C-NSCLC. PATIENTS AND METHODS A total of 186 patients with MPE-C-NSCLC were enrolled and divided into two groups. The patients in the D group were treated with only drugs. Those in the RD group were treated with drugs plus primary tumour radiotherapy. The Kaplan-Meier method was used for survival analysis, and the Log rank test was used for between-group analysis and univariate prognostic analysis. The Cox proportional hazards model was used to perform multivariate analyses to assess the impacts of factors on survival. Propensity score matching (PSM) was matched based on clinical characteristics, systematic drug treatment and drug response to further adjust for confounding factors. RESULTS The overall survival (OS) rates at 1, 2, and 3 years for the RD group and D group were 54.4%, 26.8%, and 13.3% and 31.1%, 11.5%, and 4.4%, respectively; the corresponding MSTs were 14 months and 8 months, respectively (χ 2=15.915, p<0.001). There was a significant difference in survival by PSM (p=0.027).Before PSM, multivariate analysis showed that metastasis status (organ≤3 and metastasis≤5), primary tumour radiotherapy, chemotherapy cycles≥4, and drug best response (CR+PR) were independent predictors of prolonged OS. After PSM, primary tumour radiotherapy and drug best response (CR+PR) were independent predictors of prolonged OS were still independent predictors of prolonged OS. There were no grade 4-5 radiation toxicities. CONCLUSION For MPE-C-NSCLC, the response of systemic drug treatment plays a crucial role in survival outcomes, and we also should pay attention to primary tumour radiotherapy in addition to systematic drug treatment.
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Affiliation(s)
- Qingsong Li
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Cheng Hu
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Shengfa Su
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Zhu Ma
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Yichao Geng
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Yinxiang Hu
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Huiqin Li
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Bing Lu
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
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Li Q, Liang N, Zhang X, Zhang Y, Ouyang W, Su S, Ma Z, Hu Y, Geng Y, Chen X, Lu B. Reasonable Timing of Radiotherapy for Stage IV Non-Small-Cell Lung Cancer During Targeted Therapy Based on Tumour Volume Change. Front Oncol 2021; 11:705303. [PMID: 34631535 PMCID: PMC8496348 DOI: 10.3389/fonc.2021.705303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose The aim of this study was to investigate the reasonable timing of radiotherapy for stage IV non-small-cell lung cancer (NSCLC) with EGFR-positive mutations during targeted therapy based on tumour volume change (TVC). Patients and Methods Simulation Computed Tomography Scan (SCTS) measurements were taken to test TVC in patients with stage IV NSCLC during targeted therapy at intervals of 10 days. The SCTS measurement was terminated when the tumour volume shrinkage rate in the latter simulation compared with the previous simulation was ≤5% or when the time after treatment was 90 days. Then, primary tumour radiotherapy was performed. Related parameters of the radiotherapy plan were compared between the implementation and simulation plans. Results Twenty-seven patients were enrolled in the analysis. After treatment, shrinkage of the primary tumour was observed in all patients, but the rate and speed were inconsistent. The average tumour volume decreased obviously within 40 days and was significantly different every 10 days (P ≤ 0.001). The average volume decreased slowly and tended to be stable (P>0.05) after 40 days. After the termination of SCTSs, 21 patients accepted primary tumour radiotherapy. No patients experienced grade 3+ acute radiation toxicity. The implementation radiotherapy plan was significantly better than that before treatment (all P<0.05) but not better than that on the 40th day after treatment (all P>0.05). Conclusions To obtain a high radiation dose and control radiation toxicity, the 40th day after targeted therapy may be a reasonable time to start radiotherapy for stage IV NSCLC with EGFR-positive mutations. Clinical Trial Registration https://www.clinicaltrials.gov/ct2/show/NCT03258671, identifier, NCT03258671.
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Affiliation(s)
- Qingsong Li
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Na Liang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Xia Zhang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guiyang Guihang Hospital, Guiyang, China
| | - Yi Zhang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Weiwei Ouyang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Shengfa Su
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Zhu Ma
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Yinxiang Hu
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Yichao Geng
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Xiaxia Chen
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
| | - Bing Lu
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Department of Oncology, Guizhou Cancer Hospital, Guiyang, China
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Desideri I, Loi M, Francolini G, Becherini C, Livi L, Bonomo P. Application of Radiomics for the Prediction of Radiation-Induced Toxicity in the IMRT Era: Current State-of-the-Art. Front Oncol 2020; 10:1708. [PMID: 33117669 PMCID: PMC7574641 DOI: 10.3389/fonc.2020.01708] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
Normal tissue complication probability (NTCP) models that were formulated in the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) are one of the pillars in support of everyday’s clinical radiation oncology. Because of steady therapeutic refinements and the availability of cutting-edge technical solutions, the ceiling of organs-at-risk-sparing has been reached for photon-based intensity modulated radiotherapy (IMRT). The possibility to capture heterogeneity of patients and tissues in the prediction of toxicity is still an unmet need in modern radiation therapy. Potentially, a major step towards a wider therapeutic index could be obtained from refined assessment of radiation-induced morbidity at an individual level. The rising integration of quantitative imaging and machine learning applications into radiation oncology workflow offers an unprecedented opportunity to further explore the biologic interplay underlying the normal tissue response to radiation. Based on these premises, in this review we focused on the current-state-of-the-art on the use of radiomics for the prediction of toxicity in the field of head and neck, lung, breast and prostate radiotherapy.
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Affiliation(s)
- Isacco Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Mauro Loi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
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Functional lung imaging in radiation therapy for lung cancer: A systematic review and meta-analysis. Radiother Oncol 2018; 129:196-208. [PMID: 30082143 DOI: 10.1016/j.radonc.2018.07.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/14/2018] [Accepted: 07/18/2018] [Indexed: 12/25/2022]
Abstract
RATIONALE Advanced imaging techniques allow functional information to be derived and integrated into treatment planning. METHODS A systematic review was conducted with the primary objective to evaluate the ability of functional lung imaging to predict risk of radiation pneumonitis. Secondary objectives were to evaluate dose-response relationships on post treatment functional imaging and assess the utility in including functional lung information into treatment planning. A structured search for publications was performed following PRISMA guidelines and registered on PROSPERO. RESULTS 814 articles were screened against review criteria and 114 publications met criteria. Methods of identifying functional lung included using CT, MRI, SPECT and PET to image ventilation or perfusion. Six studies compared differences between functional and anatomical lung imaging at predicting radiation pneumonitis. These found higher predictive values using functional lung imaging. Twenty-one studies identified a dose-response relationship on post-treatment functional lung imaging. Nineteen planning studies demonstrated the ability of functional lung optimised planning techniques to spare regions of functional lung. Meta-analysis of these studies found that mean (95% CI) functional volume receiving 20 Gy was reduced by 4.2% [95% CI: 2.3: 6.0] and mean lung dose by 2.2 Gy [95% CI: 1.2: 3.3] when plans were optimised to spare functional lung. There was significant variation between publications in the definition of functional lung. CONCLUSION Functional lung imaging may have potential utility in radiation therapy planning and delivery, although significant heterogeneity was identified in approaches and reporting. Recommendations have been made based on the available evidence for future functional lung trials.
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Modeling Patient-Specific Dose-Function Response for Enhanced Characterization of Personalized Functional Damage. Int J Radiat Oncol Biol Phys 2018; 102:1265-1275. [PMID: 30108006 DOI: 10.1016/j.ijrobp.2018.05.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/25/2018] [Accepted: 05/14/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Functional-guided radiation therapy (RT) plans have the potential to limit damage to normal tissue and reduce toxicity. Although functional imaging modalities have continued to improve, a limited understanding of the functional response to radiation and its application to personalized therapy has hindered clinical implementation. The purpose of this study was to retrospectively model the longitudinal, patient-specific dose-function response in non-small cell lung cancer patients treated with RT to better characterize the expected functional damage in future, unknown patients. METHODS AND MATERIALS Perfusion single-photon emission computed tomography/computed tomography scans were obtained at baseline (n = 81), midtreatment (n = 74), 3 months post-treatment (n = 51), and 1 year post-treatment (n = 26) and retrospectively analyzed. Patients were treated with conventionally fractionated RT or stereotactic body RT. Normalized perfusion single-photon emission computed tomography voxel intensity was used as a surrogate for local lung function. A patient-specific logistic model was applied to each individual patient's dose-function response to characterize functional reduction at each imaging time point. Patient-specific model parameters were averaged to create a population-level logistic dose-response model. RESULTS A significant longitudinal decrease in lung function was observed after RT by analyzing the voxelwise change in normalized perfusion intensity. Generated dose-function response models represent the expected voxelwise reduction in function, and the associated uncertainty, for an unknown patient receiving conventionally fractionated RT or stereotactic body RT. Differential treatment responses based on the functional status of the voxel at baseline suggest that initially higher functioning voxels are damaged at a higher rate than lower functioning voxels. CONCLUSIONS This study modeled the patient-specific dose-function response in patients with non-small cell lung cancer during and after radiation treatment. The generated population-level dose-function response models were derived from individual patient assessment and have the potential to inform functional-guided treatment plans regarding the expected functional lung damage. This type of patient-specific modeling approach can be applied broadly to other functional response analyses to better capture intrapatient dependencies and characterize personalized functional damage.
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Jumeau R, Peguret N, de Bari B, Moeckli R, Soares-Rodrigues JL, Durham AD, Hojnowski S, Bourhis J, Ozsahin M, Beigelman-Aubry C. Sparing healthy lung by focusing the radiation beam flow onto the emphysematous regions in the treatment of lung cancer. J Med Imaging Radiat Oncol 2017; 61:252-257. [DOI: 10.1111/1754-9485.12516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 08/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Raphael Jumeau
- Department of Radiation Oncology; Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Switzerland
| | - Nicolas Peguret
- Department of Radiation Oncology; Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Switzerland
| | - Berardino de Bari
- Department of Radiation Oncology; Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Switzerland
| | - Raphael Moeckli
- Institute of Radiation Physics; Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Switzerland
| | - Joao-Luis Soares-Rodrigues
- Institute of Radiation Physics; Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Switzerland
| | - Andrea Dante Durham
- Department of Radiation Oncology; Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Switzerland
| | | | - Jean Bourhis
- Department of Radiation Oncology; Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology; Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Switzerland
| | - Catherine Beigelman-Aubry
- Department of Radiology; Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Switzerland
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Role of functional imaging in treatment plan optimization of stereotactic body radiation therapy for liver cancer. TUMORI JOURNAL 2016; 102:e21-e24. [PMID: 27443895 DOI: 10.5301/tj.5000523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 11/20/2022]
Abstract
We report the first known instance of the clinical use of 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) for the optimization of radiotherapy treatment planning and for the follow-up of acute toxicity in a patient undergoing stereotactic body radiation therapy for hepatocellular carcinoma. In our experience, HBS allowed the identification and the sparing of more functioning liver areas, thus potentially reducing the risk of radiation-induced liver toxicity.
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De Bari B, Deantonio L, Bourhis J, Prior JO, Ozsahin M. Should we include SPECT lung perfusion in radiotherapy treatment plans of thoracic targets? Evidences from the literature. Crit Rev Oncol Hematol 2016; 102:111-7. [PMID: 27132077 DOI: 10.1016/j.critrevonc.2016.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/08/2016] [Accepted: 04/19/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To report the available data about the potential impact of integrating lung perfusion SPECT/CT in treatment plans optimization for the irradiation of thoracic targets. MATERIALS AND METHODS We searched in the PubMed and Scopus databases, English-written articles published from 2000 to June 2015 dealing with the integration of perfusion SPECT/CT in radiotherapy. RESULTS We found and analyzed 16 research articles (10 dosimetric, 6 clinical) for a total of 578 patients. Available data suggest dosimetric and clinical improvements when perfusion SPEC/CT is integrated in the radiotherapy treatment planing of selected patients with thoracic targets. In particular, patients presenting emphysema and/or large areas of deficit of perfusion show the most important improvements. Moreover, some studies show different risk of radiation pneumonitis (RP) depending on the localization of the tumor in the lungs: patients with low-located tumors, present an increased risk of RP, and functional data could be a benefit in treatment plan optimization. Unfortunately, none of the available studies finally reports any dosimetric constraint, which could be used in the clinical practice, even if most of them used the cut-off of the 30% of the maximal perfusion value to define the well-functioning lung. CONCLUSIONS Published data support the integration of lung perfusion scintigraphy in some selected categories of patients. Prospective studies should be designed to define the best candidates, and to assess the clinical advantage of this kind of optimization.
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Affiliation(s)
- Berardino De Bari
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland
| | - Letizia Deantonio
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland
| | - Jean Bourhis
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland
| | - John O Prior
- Nuclear Medicine and Molecular Medicine Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland
| | - Mahmut Ozsahin
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
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Huang W, Liu B, Fan M, Zhou T, Fu Z, Zhang Z, Li H, Li B. The early predictive value of a decrease of metabolic tumor volume in repeated 18 F-FDG PET/CT for recurrence of locally advanced non-small cell lung cancer with concurrent radiochemotherapy. Eur J Radiol 2015; 84:482-488. [DOI: 10.1016/j.ejrad.2014.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 11/11/2014] [Accepted: 11/15/2014] [Indexed: 12/28/2022]
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Castillo R, Pham N, Castillo E, Aso-Gonzalez S, Ansari S, Hobbs B, Palacio D, Skinner H, Guerrero TM. Pre-Radiation Therapy Fluorine 18 Fluorodeoxyglucose PET Helps Identify Patients with Esophageal Cancer at High Risk for Radiation Pneumonitis. Radiology 2015; 275:822-31. [PMID: 25584706 DOI: 10.1148/radiol.14140457] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine the association between pre-radiation therapy (RT) fluorine 18 fluorodeoxyglucose (FDG) uptake and post-RT symptomatic radiation pneumonitis (RP). MATERIALS AND METHODS In accordance with the retrospective study protocol approved by the institutional review board, 228 esophageal cancer patients who underwent FDG PET/CT before chemotherapy and RT were examined. RP symptoms were evaluated by using the Common Terminology Criteria for Adverse Events, version 4.0, from the consensus of five clinicians. By using the cumulative distribution of standardized uptake values (SUVs) within the lungs, those values greater than 80%-95% of the total lung voxels were determined for each patient. The effect of pre-chemotherapy and RT FDG uptake, dose, and patient or treatment characteristics on RP toxicity was studied by using logistic regression. RESULTS The study subjects were treated with three-dimensional conformal RT (n = 36), intensity-modulated RT (n = 135), or proton therapy (n = 57). Logistic regression analysis demonstrated elevated FDG uptake at pre-chemotherapy and RT was related to expression of RP symptoms. Study subjects with elevated 95% percentile of the SUV (SUV95) were more likely to develop symptomatic RP (P < .000012); each 0.1 unit increase in SUV95 was associated with a 1.36-fold increase in the odds of symptomatic RP. Receiver operating characteristic (ROC) curve analysis resulted in area under the ROC curve of 0.676 (95% confidence interval: 0.58, 0.77), sensitivity of 60%, and specificity of 71% at the 1.17 SUV95 threshold. CT imaging and dosimetric parameters were found to be poor predictors of RP symptoms. CONCLUSION The SUV95, a biomarker of pretreatment pulmonary metabolic activity, was shown to be prognostic of symptomatic RP. Elevation in this pretreatment biomarker identifies patients at high risk for posttreatment symptomatic RP.
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Affiliation(s)
- Richard Castillo
- From the Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, Tex (R.C.); Department of Radiation Oncology, Baylor College of Medicine, Houston, Tex (N.P.); Department of Radiation Oncology, Beaumont Health System, 3601 W Thirteen Mile Rd, Royal Oak, MI 48073-6769 (E.C., T.M.G.); Department of Computational and Applied Mathematics, Rice University, Houston, Tex (E.C., T.M.G.); Department of Pulmonology, Bellvitge Hospital, University of Barcelona, Barcelona, Spain (S.A.G.); Department of Radiation Oncology, University of Chicago, Chicago, Ill (S.A.); and Divisions of Quantitative Sciences (B.H.), Diagnostic Imaging (D.P.), and Radiation Oncology (H.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Functional and biologic metrics for predicting radiation pneumonitis in locally advanced non-small cell lung cancer patients treated with chemoradiotherapy. Clin Transl Oncol 2012; 14:943-52. [PMID: 22855174 DOI: 10.1007/s12094-012-0890-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 02/19/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To study the predictive value of functional and biologic metrics for predicting radiation pneumonitis (RP) in locally advanced non-small cell lung cancer (LANSCLC) patients treated with chemoradiotherapy. METHODS Between March 2006 and April 2010, 57 LANSCLC patients were enrolled in a prospective study. Fusion of SPECT and computed tomography scans provides perfusion-weighted functional dose-volume histogram (DVH) and associated functional dosimetric parameters. Blood for serum biomarkers-interleukin-6 (IL-6), transforming growth factor-beta1, and superoxide dismutase (SOD)-was drawn pre-RT and then 40 Gy/4 weeks during the treatment. The incidence of RP was related to the functional and biologic metrics. The predictability of predictors was calculated and compared based on the area under receiver-operating characteristic (ROC) curve (AUC). RESULTS Relative volumes of functional lung receiving more than a threshold dose of 5-50 Gy at increments of 5 Gy and elevated levels of serum SOD after delivery of 40 Gy/4 weeks were associated with RP (p < 0.05). The best predictive efficacy of SOD was observed for a cutoff value of 56 U/ml, with a sensitivity of 0.80 (95 % CI 0.28-0.99) and a specificity of 0.67 (95 % CI 0.43-0.65) (p = 0.040). Functional DVH provided better predictive outcome (AUC 0.76-0.98) than standard DVH (AUC 0.62-0.86) for patients with poor baseline lung function. CONCLUSION Functional metrics were identified to be better predictors for RP in patients with poor baseline lung function. SOD seemed to be a potential predictor for RP; however, it will need to be further verified using a larger sample size.
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