Journal article
Metrics of dose to highly ventilated lung are predictive of radiation-induced pneumonitis in lung cancer patients
Radiotherapy and oncology, Vol.182, 109553
02/20/2023
DOI: 10.1016/j.radonc.2023.109553
PMCID: PMC10283046
PMID: 36813178
Abstract
•Current lung cancer radiotherapy planning does not account for regional variation in pulmonary function.•Regional lung function can be quantified through derivation of ventilation obtained from 4DCT imaging.•In this study dose to highly ventilated lung was found to be associated with symptomatic pneumonitis.•These findings provide important metrics to be used in functional lung avoidance radiotherapy planning and in designing clinical trials.
To identify metrics of radiation dose delivered to highly ventilated lung that are predictive of radiation-induced pneumonitis.
A cohort of 90 patients with locally advanced non-small cell lung cancer treated with standard fractionated radiation therapy (RT) (60–66 Gy in 30–33 fractions) were evaluated. Regional lung ventilation was determined from pre-RT 4-dimensional computed tomography (4DCT) using the Jacobian determinant of a B-spline deformable image registration to estimate lung tissue expansion during respiration. Multiple voxel-wise population- and individual-based thresholds for defining high functioning lung were considered. Mean dose and volumes receiving dose ≥ 5–60 Gy were analyzed for both total lung-ITV (MLD,V5-V60) and highly ventilated functional lung-ITV (fMLD,fV5-fV60). The primary endpoint was symptomatic grade 2+ (G2+) pneumonitis. Receiver operator curve (ROC) analyses were used to identify predictors of pneumonitis.
G2+ pneumonitis occurred in 22.2% of patients, with no differences between stage, smoking status, COPD, or chemo/immunotherapy use between G<2 and G2+ patients (P≥ 0.18). Highly ventilated lung was defined as voxels exceeding the population-wide median of 18% voxel-level expansion. All total and functional metrics were significantly different between patients with and without pneumonitis (P≤ 0.039). Optimal ROC points predicting pneumonitis from functional lung dose were fMLD ≤ 12.3 Gy, fV5 ≤ 54% and fV20 ≤ 19 %. Patients with fMLD ≤ 12.3 Gy had a 14% risk of developing G2+ pneumonitis whereas risk significantly increased to 35% for those with fMLD > 12.3 Gy (P = 0.035).
Dose to highly ventilated lung is associated with symptomatic pneumonitis and treatment planning strategies should focus on limiting dose to functional regions. These findings provide important metrics to be used in functional lung avoidance RT planning and designing clinical trials.
Details
- Title: Subtitle
- Metrics of dose to highly ventilated lung are predictive of radiation-induced pneumonitis in lung cancer patients
- Creators
- Mattison J. Flakus - University of Wisconsin–MadisonSean P. Kent - University of Wisconsin–MadisonEric M. Wallat - University of Wisconsin–MadisonAntonia E. Wuschner - University of Wisconsin–MadisonErica Tennant - University of Wisconsin School of Medicine and Public HealthPoonam Yadav - Northwestern UniversityAdam Burr - UW Health University HospitalMenggang Yu - UW Health University HospitalGary E Christensen - University of IowaJoseph M. Reinhardt - University of IowaJohn E. Bayouth - Oregon Health & Science UniversityAndrew M. Baschnagel - UW Health University Hospital
- Resource Type
- Journal article
- Publication Details
- Radiotherapy and oncology, Vol.182, 109553
- DOI
- 10.1016/j.radonc.2023.109553
- PMID
- 36813178
- PMCID
- PMC10283046
- NLM abbreviation
- Radiother Oncol
- ISSN
- 0167-8140
- eISSN
- 1879-0887
- Publisher
- Elsevier B.V
- Grant note
- DOI: 10.13039/100019229, name: ViewRay; DOI: 10.13039/100000002, name: National Institutes of Health, award: CA 166703; DOI: 10.13039/100007015, name: University of Wisconsin-Madison, award: P30 CA014520; DOI: 10.13039/100007923, name: University of Wisconsin Carbone Cancer Center
- Language
- English
- Date published
- 02/20/2023
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Electrical and Computer Engineering; Radiation Oncology; Radiation Research Laboratory; The Iowa Institute for Biomedical Imaging; Advanced Pulmonary Physiomic Imaging Laboratory; Holden Comprehensive Cancer Center
- Record Identifier
- 9984375357302771
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