A novel Lung-avoidance Planning Strategy Based on 4DCT Ventilation Imaging and CT Density Characteristics for Stage III Non-small-cell Lung Cancer Patients

Overview

Journal Strahlenther Onkol

Specialties Oncology
Radiology

Date 2021 Aug 5

PMID 34351454

Citations 4

Authors

Aihui Feng

Yan Shao

Hao Wang

Hua Chen

HengLe Gu

Yanhua Duan

Wutian Gan

Zhiyong Xu

Affiliations

Soon will be listed here.

Abstract

Background: Functional planning based merely on 4DCT ventilation imaging has limitations. In this study, we proposed a radiotherapy planning strategy based on 4DCT ventilation imaging and CT density characteristics.

Materials And Methods: For 20 stage III non-small-cell lung cancer (NSCLC) patients, clinical plans and lung-avoidance plans were generated. Through deformable image registration (DIR) and quantitative image analysis, a 4DCT ventilation map was calculated. High-, medium-, and low-ventilation regions of the lung were defined based on the ventilation value. In addition, the total lung was also divided into high-, medium-, and low-density areas according to the HU threshold. The lung-avoidance plan aimed to reduce the dose to functional and high-density lungs while meeting standard target and critical structure constraints. Standard and dose-function metrics were compared between the clinical and lung-avoidance plans.

Results: Lung avoidance plans led to significant reductions in high-function and high-density lung doses, without significantly increasing other organ at risk (OAR) doses, but at the expense of a significantly degraded homogeneity index (HI) and conformity index (CI; p < 0.05) of the planning target volume (PTV) and a slight increase in monitor units (MU) as well as in the number of segments (p > 0.05). Compared with the clinical plan, the mean lung dose (MLD) in the high-function and high-density areas was reduced by 0.59 Gy and 0.57 Gy, respectively.

Conclusion: A lung-avoidance plan based on 4DCT ventilation imaging and CT density characteristics is feasible and implementable, with potential clinical benefits. Clinical trials will be crucial to show the clinical relevance of this lung-avoidance planning strategy.

Citing Articles

Incorporation of Functional Lung Imaging Into Radiation Therapy Planning in Patients With Lung Cancer: A Systematic Review and Meta-Analysis.

Midroni J, Salunkhe R, Liu Z, Chow R, Boldt G, Palma D Int J Radiat Oncol Biol Phys. 2024; 120(2):370-408.

PMID: 38631538 PMC: 11580018. DOI: 10.1016/j.ijrobp.2024.04.001.

An analysis of the regional heterogeneity in tissue elasticity in lung cancer patients with COPD.

Lauria M, Stiehl B, Santhanam A, OConnell D, Naumann L, McNitt-Gray M Front Med (Lausanne). 2023; 10:1151867.

PMID: 37840998 PMC: 10575648. DOI: 10.3389/fmed.2023.1151867.

Clinical application of breathing-adapted 4D CT: image quality comparison to conventional 4D CT.

Werner R, Szkitsak J, Madesta F, Buttgen L, Wimmert L, Sentker T Strahlenther Onkol. 2023; 199(7):686-691.

PMID: 37000223 PMC: 10281893. DOI: 10.1007/s00066-023-02062-0.

First clinical experience with a novel, mobile cone-beam CT system for treatment quality assurance in brachytherapy.

Karius A, Strnad V, Lotter M, Kreppner S, Bert C Strahlenther Onkol. 2022; 198(6):573-581.

PMID: 35278094 PMC: 9165284. DOI: 10.1007/s00066-022-01912-7.

References

Faught A, Miyasaka Y, Kadoya N, Castillo R, Castillo E, Vinogradskiy Y . Evaluating the Toxicity Reduction With Computed Tomographic Ventilation Functional Avoidance Radiation Therapy. Int J Radiat Oncol Biol Phys. 2017; 99(2):325-333. PMC: 5605907. DOI: 10.1016/j.ijrobp.2017.04.024. View

Jiang Z, Yang K, Komaki R, Wei X, Tucker S, Zhuang Y . Long-term clinical outcome of intensity-modulated radiotherapy for inoperable non-small cell lung cancer: the MD Anderson experience. Int J Radiat Oncol Biol Phys. 2011; 83(1):332-9. DOI: 10.1016/j.ijrobp.2011.06.1963. View

Zhang G, Latifi K, Du K, Reinhardt J, Christensen G, Ding K . Evaluation of the ΔV 4D CT ventilation calculation method using in vivo xenon CT ventilation data and comparison to other methods. J Appl Clin Med Phys. 2016; 17(2):550-560. PMC: 5874808. DOI: 10.1120/jacmp.v17i2.5985. View

Tsujino K, Hirota S, Endo M, Obayashi K, Kotani Y, Satouchi M . Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys. 2002; 55(1):110-5. DOI: 10.1016/s0360-3016(02)03807-5. View

Defraene G, van Elmpt W, De Ruysscher D . Regional lung avoidance by CT numbers to reduce radiation-induced lung damage risk in non-small-cell lung cancer: a simulation study. Acta Oncol. 2019; 59(2):201-207. DOI: 10.1080/0284186X.2019.1669814. View

Du K, Bayouth J, Cao K, Christensen G, Ding K, Reinhardt J . Reproducibility of registration-based measures of lung tissue expansion. Med Phys. 2012; 39(3):1595-608. PMC: 3306443. DOI: 10.1118/1.3685589. View

De Ruysscher D, Sharifi H, Defraene G, Kerns S, Christiaens M, De Ruyck K . Quantification of radiation-induced lung damage with CT scans: the possible benefit for radiogenomics. Acta Oncol. 2013; 52(7):1405-10. DOI: 10.3109/0284186X.2013.813074. View

Defraene G, van Elmpt W, Crijns W, De Ruysscher D . Regional variability in radiation-induced lung damage can be predicted by baseline CT numbers. Radiother Oncol. 2016; 122(2):300-306. DOI: 10.1016/j.radonc.2016.11.021. View

Doi Y, Kimura T, Nakashima T, Takeuchi Y, Takahashi I, Nishibuchi I . Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma. Adv Radiat Oncol. 2017; 2(2):183-191. PMC: 5514243. DOI: 10.1016/j.adro.2017.01.011. View

10.

OReilly S, Jain V, Huang Q, Cheng C, Teo B, Yin L . Dose to Highly Functional Ventilation Zones Improves Prediction of Radiation Pneumonitis for Proton and Photon Lung Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys. 2020; 107(1):79-87. DOI: 10.1016/j.ijrobp.2020.01.014. View

11.

Yamamoto T, Kabus S, Bal M, Keall P, Benedict S, Daly M . The first patient treatment of computed tomography ventilation functional image-guided radiotherapy for lung cancer. Radiother Oncol. 2015; 118(2):227-31. DOI: 10.1016/j.radonc.2015.11.006. View

12.

Yaremko B, Capaldi D, Sheikh K, Palma D, Warner A, Dar A . Functional Lung Avoidance for Individualized Radiation Therapy: Results of a Double-Masked, Randomized Controlled Trial. Int J Radiat Oncol Biol Phys. 2022; 113(5):1072-1084. DOI: 10.1016/j.ijrobp.2022.04.047. View

13.

Brennan D, Schubert L, Diot Q, Castillo R, Castillo E, Guerrero T . Clinical validation of 4-dimensional computed tomography ventilation with pulmonary function test data. Int J Radiat Oncol Biol Phys. 2015; 92(2):423-9. PMC: 4431937. DOI: 10.1016/j.ijrobp.2015.01.019. View

14.

Mathew L, Wheatley A, Castillo R, Castillo E, Rodrigues G, Guerrero T . Hyperpolarized (3)He magnetic resonance imaging: comparison with four-dimensional x-ray computed tomography imaging in lung cancer. Acad Radiol. 2012; 19(12):1546-53. DOI: 10.1016/j.acra.2012.08.007. View

15.

Yamamoto T, Kabus S, Lorenz C, Johnston E, Maxim P, Diehn M . 4D CT lung ventilation images are affected by the 4D CT sorting method. Med Phys. 2013; 40(10):101907. PMC: 3785523. DOI: 10.1118/1.4820538. View

16.

Kadoya N, Cho S, Kanai T, Onozato Y, Ito K, Dobashi S . Dosimetric impact of 4-dimensional computed tomography ventilation imaging-based functional treatment planning for stereotactic body radiation therapy with 3-dimensional conformal radiation therapy. Pract Radiat Oncol. 2015; 5(5):e505-e512. DOI: 10.1016/j.prro.2015.03.001. View

17.

Ghobadi G, Hogeweg L, Faber H, Tukker W, Schippers J, Brandenburg S . Quantifying local radiation-induced lung damage from computed tomography. Int J Radiat Oncol Biol Phys. 2010; 76(2):548-56. DOI: 10.1016/j.ijrobp.2009.08.058. View

18.

Yamamoto T, Kabus S, von Berg J, Lorenz C, Chung M, Hong J . Reproducibility of four-dimensional computed tomography-based lung ventilation imaging. Acad Radiol. 2012; 19(12):1554-65. PMC: 5357435. DOI: 10.1016/j.acra.2012.07.006. View

19.

Schroder C, Engenhart-Cabillic R, Kirschner S, Blank E, Buchali A . Changes of lung parenchyma density following high dose radiation therapy for thoracic carcinomas - an automated analysis of follow up CT scans. Radiat Oncol. 2019; 14(1):72. PMC: 6489276. DOI: 10.1186/s13014-019-1276-2. View

20.

Du K, Reinhardt J, Christensen G, Ding K, Bayouth J . Respiratory effort correction strategies to improve the reproducibility of lung expansion measurements. Med Phys. 2013; 40(12):123504. PMC: 3843762. DOI: 10.1118/1.4829519. View