High-resolution pulmonary ventilation and perfusion PET/CT allows for functionally adapted intensity modulated radiotherapy in lung cancer

Siva, Shankar; Thomas, R. J. S.; Callahan, Jason; Hardcastle, Nicholas; Pham, Daniel; Kron, Tomas; Hicks, Rodney J.; MacManus, Michael; Ball, David; Hofman, Michael S

doi:10.1016/j.radonc.2015.04.013

Cited by 90 publications

(69 citation statements)

References 25 publications

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“…There are several studies that report on functional avoidance treatment planning using either SPECT [19, 20, 23], 4DCT-ventilation [12, 26], or PET/CT [22]. Although most of these studies did not explicitly separate their data according to disease stage, comparisons can be made with their data for conventional plans (plans not optimized for functional avoidance) and our results.…”

Section: Discussionmentioning

confidence: 86%

“…We calculated standard dose-volume metrics including mean lung dose (MLD) as well as V5 (volume of lung receiving ≥5 Gy), V10, V20, and V30. Three different types of dose-function metrics previously presented in the literature were calculated: 1) functionally weighted mean lung doses (fMLD) [11, 19, 20], 2) metrics based on the dose-function histogram (DFH) [21, 22] including functional V5 (referred to as fV5), fV10, fV20, fV30, and 3) the mean doses to the highest 80% functional portions of the lung (referred to as meanF80) [12, 13, 23]. The fMLD values were calculated by scaling the dose at each voxel by the corresponding 4DCT-ventilation value and calculating the average of the scaled doses for all the voxels in the lung [11, 19, 20].…”

Section: Methodsmentioning

confidence: 99%

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Regional Lung Function Profiles of Stage I and III Lung Cancer Patients: An Evaluation for Functional Avoidance Radiation Therapy

Vinogradskiy

Schubert

Diot

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose 4DCT-ventilation is an exciting imaging modality that uses 4DCT data to calculate lung function maps. The development of clinical trials is underway to use 4DCT-ventilation imaging to preferentially spare functional lung in patients undergoing radiotherapy. The purpose of this work was to generate data to aide with clinical trial design by retrospectively characterizing dosimetric and functional profiles for patients with different stages of lung cancer disease Methods and Materials A total of 118 lung cancer patients (36% stage I and 64% stage III) from 2 institutions were used for the study. A 4DCT-ventilation map was calculated using the patient’s 4DCT imaging, deformable image registration, and a density-change based algorithm. In order to assess each patient’s spatial ventilation profile both quantitative and qualitative metrics were developed including an observer-based defect observation and metrics based on the ventilation in each lung third. For each patient we used the clinical doses to calculate weighted mean lung doses (fMLD) and metrics that assessed the interplay between the spatial location of the dose and high-functioning lung. Results Both qualitative and quantitative metrics revealed a significant difference in functional profiles between the 2 stage groups (p<0.01). We determined that 65% of stage III and 28% of stage I patients had ventilation defects. Average fMLD was 19.6 Gy and 5.4 Gy for stage III and I patients respectively with both groups containing patients with large spatial overlap between dose and high-function regions. Conclusion Our 118 patient retrospective study found that 65% stage III patients have regionally variant ventilation profiles that are suitable for functional avoidance. Our results suggest that regardless of disease stage, it is possible to have unique spatial interplay between dose and high-functional lung highlighting the importance of evaluating the function of each patient and developing a personalized functional avoidance treatment approach.

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Section: Discussionmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Regional Lung Function Profiles of Stage I and III Lung Cancer Patients: An Evaluation for Functional Avoidance Radiation Therapy

Vinogradskiy

Schubert

Diot

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…Recent developments in high-resolution pulmonary ventilation and perfusion PET/CT technology allowed for functionally adapted IMRT planning in lung cancer [40]. However, these methods are currently not available for widespread clinical use.…”

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confidence: 99%

Inclusion of functional information from perfusion SPECT improves predictive value of dose–volume parameters in lung toxicity outcome after radiotherapy for non-small cell lung cancer: A prospective study

Farr

Kallehauge

Møller

et al. 2015

Radiotherapy and Oncology

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“…Functional avoidance planning has been previously explored using SPECT(38-40), PET/CT(41), and CT-ventilation imaging(2,13). The average functional volume receiving ≥20Gy (fV20Gy) and mean dose to functional lung (fMLD), 26.8% and 17.8Gy, respectively, were comparable to a previous study (33.8% and 18.3Gy)(42) investigating the potential dosimetric savings of functional avoidance planning using CT-ventilation imaging.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Toxicity Reduction With Computed Tomographic Ventilation Functional Avoidance Radiation Therapy

Faught

Miyasaka

Kadoya

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Summary A retrospective study of 70 lung cancer patients with 4DCT images was performed to estimate the toxicity reduction achieved when using CT-ventilation functional avoidance radiotherapy in place of traditional radiotherapy. Normal tissue complication probability (NTCP) models were developed from clinically used plans based on dose to functional lung. Thirty patients were re-planned using functional avoidance techniques and RTOG 0617 constraints, and the reduction in lung toxicity was assessed using the NTCP models. Purpose CT-ventilation imaging is a new modality that uses 4DCT information to calculate lung ventilation. While retrospective studies have reported on the reduction in dose to functional lung, no work has been published in which the dosimetric improvements have been translated to a reduction in the probability of pulmonary toxicity. Our work estimates the reduction in toxicity for CT-ventilation based functional avoidance planning. Methods and Materials Seventy previously treated lung cancer patients with 4DCT imaging were used for the study. CT-ventilation maps were calculated using the 4DCT, deformable image registration, and a density-change-based algorithm. Pneumonitis was graded based on imaging and clinical presentation. Maximum-likelihood methods were used to generate normal tissue complication probability (NTCP) models predicting grade 2 or higher (2+) and grade 3+ pneumonitis as a function of dose (V5Gy, V10Gy, V20Gy, V30Gy, and mean dose) to functional lung. For thirty patients a functional plan was generated with the goal of reducing dose to the functional lung while meeting RTOG 0617 constraints. The NTCP models were applied to the functional plans and the clinically-used plans to calculate toxicity reduction. Results Using functional avoidance planning, absolute reductions in grade 2+ NTCP of 6.3%, 7.8% and 4.8% were achieved based on the mean fV20Gy, fV30Gy, and fMLD metrics, respectively. Absolute grade 3+ NTCP reductions of 3.6%, 4.8%, and 2.4% were achieved with fV20Gy, fV30Gy, and fMLD. Maximum absolute reductions of 52.3% and 16.4% were seen for grade 2+ and grade 3+ pneumonitis for individual patients. Conclusion Our study quantifies the possible toxicity reduction from CT-ventilation-based functional avoidance planning. Reductions in grades 2+ and 3+ pneumonitis were 7.1% and 4.7% based on mean dose-function metrics with reductions as high as 52.3% for individual patients. Our work provides seminal data for determining the potential toxicity benefit from incorporating CT-ventilation into thoracic treatment planning.

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High-resolution pulmonary ventilation and perfusion PET/CT allows for functionally adapted intensity modulated radiotherapy in lung cancer

Cited by 90 publications

References 25 publications

Regional Lung Function Profiles of Stage I and III Lung Cancer Patients: An Evaluation for Functional Avoidance Radiation Therapy

Regional Lung Function Profiles of Stage I and III Lung Cancer Patients: An Evaluation for Functional Avoidance Radiation Therapy

Inclusion of functional information from perfusion SPECT improves predictive value of dose–volume parameters in lung toxicity outcome after radiotherapy for non-small cell lung cancer: A prospective study

Evaluating the Toxicity Reduction With Computed Tomographic Ventilation Functional Avoidance Radiation Therapy

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