A new CT-based method to quantify radiation-induced lung damage in patients

Ghobadi, Ghazaleh; Wiegman, Erwin M.; Langendijk, Johannes A.; Widder, Joachim; Coppes, Robert P.; Luijk, Peter van

doi:10.1016/j.radonc.2015.07.017

Cited by 31 publications

(25 citation statements)

References 25 publications

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“…Quantification of lung density changes has been investigated for patient-specific susceptibility of radiation-induced lung damage following SABR [64]. A recent study by Ghobadi et al [65] showed that the combination of mean density changes with the standard deviation of the density was a more sensitive and specific method to assess radiationinduced lung damage than measuring differences in mean density. Predictive modelling of radiation pneumonitis using texture analysis on CT has been studied following definitive radiation for lung and esophageal cancer [66,67].…”

Section: Sensitivity (%) Specificity (%)mentioning

confidence: 99%

Pulmonary imaging after stereotactic radiotherapy—does RECIST still apply?

Mattonen¹,

Ward²,

Palma³

2016

BJR

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The use of stereotactic ablative radiotherapy (SABR) for the treatment of primary lung cancer and metastatic disease is rapidly increasing. However, the presence of benign fibrotic changes on CT imaging makes response assessment following SABR a challenge, as these changes develop with an appearance similar to tumour recurrence. Misclassification of benign fibrosis as local recurrence has resulted in unnecessary interventions, including biopsy and surgical resection. Response evaluation criteria in solid tumours (RECIST) are widely used as a universal set of guidelines to assess tumour response following treatment. However, in the context of non-spherical and irregular post-SABR fibrotic changes, the RECIST criteria can have several limitations. Positron emission tomography can also play a role in response assessment following SABR; however, false-positive results in regions of inflammatory lung post-SABR can be a major clinical issue and optimal standardized uptake values to distinguish fibrosis and recurrence have not been determined. Although validated CT high-risk features show a high sensitivity and specificity for predicting recurrence, most recurrences are not detected until more than 1-year post-treatment. Advanced quantitative radiomic analysis on CT imaging has demonstrated promise in distinguishing benign fibrotic changes from local recurrence at earlier time points, and more accurately, than physician assessment. Overall, the use of RECIST alone may prove inferior to novel metrics of assessing response.

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Section: Sensitivity (%) Specificity (%)mentioning

confidence: 99%

Pulmonary imaging after stereotactic radiotherapy—does RECIST still apply?

Mattonen¹,

Ward²,

Palma³

2016

BJR

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“…We accounted for the massive multiple comparison (MC) problem, which may arise in the analysis of imaging data when the statistical analysis is run separately for each voxel, by applying nonparametric procedures based on randomization/permutation testing (6). Whereas imaging-based methods have been developed to measure individual patient reactions to lung irradiation (7–10), we are unaware of studies that apply this approach to explore the lung dosimetric patterns associated with RILD.…”

Section: Introductionmentioning

confidence: 99%

A Voxel-Based Approach to Explore Local Dose Differences Associated With Radiation-Induced Lung Damage

Palma

Monti

D’Avino

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose To apply a voxel-based (VB) approach aimed at exploring local dose differences associated with late radiation-induced lung damage (RILD). Methods and Materials An interinstitutional database of 98 patients who were Hodgkin lymphoma (HL) survivors treated with postchemotherapy supradiaphragmatic radiation therapy was analyzed in the study. Eighteen patients experienced late RILD, classified according to the Radiation Therapy Oncology Group scoring system. Each patient’s computed tomographic (CT) scan was normalized to a single reference case anatomy (common coordinate system, CCS) through a log-diffeomorphic approach. The obtained deformation fields were used to map the dose of each patient into the CCS. The coregistration robustness and the dose mapping accuracy were evaluated by geometric and dose scores. Two different statistical mapping schemes for nonparametric multiple permutation inference on dose maps were applied, and the corresponding P<.05 significance lung subregions were generated. A receiver operating characteristic (ROC)-based test was performed on the mean dose extracted from each subregion. Results The coregistration process resulted in a geometrically robust and accurate dose warping. A significantly higher dose was consistently delivered to RILD patients in voxel clusters near the peripheral medial-basal portion of the lungs. The area under the ROC curves (AUC) from the mean dose of the voxel clusters was higher than the corresponding AUC derived from the total lung mean dose. Conclusions We implemented a framework including a robust registration process and a VB approach accounting for the multiple comparison problem in dose-response modeling, and applied it to a cohort of HL survivors to explore a local dose–RILD relationship in the lungs. Patients with RILD received a significantly greater dose in parenchymal regions where low doses (~6 Gy) were delivered. Interestingly, the relation between differences in the high-dose range and RILD seems to lack a clear spatial signature.

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“…Our imaging biomarkers are novel. Other groups have proposed methods using feature analysis and deformable image registration to score parenchymal change characteristic of acute RILD (i.e., radiation pneumonitis) [34][35][36]. This methodology is less applicable to chronic RILD due to the increased complexity of thoracic anatomical change.…”

Section: Discussionmentioning

confidence: 99%