Anatomic, functional and molecular imaging in lung cancer precision radiation therapy: treatment response assessment and radiation therapy personalization

Abstract

This article reviews key imaging modalities for lung cancer patients treated with radiation therapy (RT) and considers their actual or potential contributions to critical decision-making. An international group of researchers with expertise in imaging in lung cancer patients treated with RT considered the relevant literature on modalities, including computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). These perspectives were coordinated to summarize the current status of imaging in lung cancer and flag developments with future implications.Although there are no useful randomized trials of different imaging modalities in lung cancer, multiple prospective studies indicate that management decisions are frequently impacted by the use of complementary imaging modalities, leading both to more appropriate treatments and better outcomes. This is especially true of 18 F-fluoro-deoxyglucose (FDG)-PET/CT which is widely accepted to be the standard imaging modality for staging of lung cancer patients, for selection for potentially curative RT and for treatment planning. PET is also more accurate than CT for predicting survival after RT. PET imaging during RT is also correlated with survival and makes response-adapted therapies possible. PET tracers other than FDG have potential for imaging important biological process in tumors, including hypoxia and proliferation. MRI has superior accuracy in soft tissue imaging and the MRI Linac is a rapidly developing technology with great potential for online monitoring and modification of treatment. The role of imaging in RT-treated lung cancer patients is evolving rapidly and will allow increasing personalization of therapy according to the biology of both the tumor and dose limiting normal tissues.

<p>Pulmonary delivery of transferrin receptors targeting peptide surface-functionalized liposomes augments the chemotherapeutic effect of quercetin in lung cancer therapy</p>

“…The two main types of lung cancer are non-small-cell lung cancer (NSCLC) and small-cell lung cancer, contributing to ~85% and ~15% of lung cancer cases, respectively 4. Lung computed tomography scans are helpful in the detection of early stage cancers,5 and the cessation of smoking is recommended to decrease the lung cancer mortality rate 6. Therefore, efficient treatment for lung cancer with less adverse effects is the need of the hour.…”

Deforming to Best Practice: Key considerations for deformable image registration in radiotherapy

“…There is potential for significant advances in quantitative response assessment, beyond the Response Evaluation Criteria In Solid Tumours (RECIST) rules 54 . Combining functional imaging with DIR methods is creating new opportunities such as mapping changes in lung function with perfusion and ventilation imaging 55–57 . Future advances in radiomics will also need to work with or alongside DIR 58,59 …”

“…54 Combining functional imaging with DIR methods is creating new opportunities such as mapping changes in lung function with perfusion and ventilation imaging. [55][56][57] Future advances in radiomics will also need to work with or alongside DIR. 58,59 Implementation of DIR…”

LungRegNet: An unsupervised deformable image registration method for 4D‐CT lung

“…Deformable image registration (DIR) of four-dimensional computed tomography (4D-CT) lung images is important in multiple radiation therapy applications including lung motion tracking, 1 target definition, 2 image fusion, 3 gated treatment planning 4 and treatment response evaluations. 5 Though DIR of 4D-CT lung has been extensively studied over the past few decades, 6,7 it remains challenging to accurately and quickly register 4D-CT lung images due to the large lung motion and bulky image sizes. To meet the increasingly demanding medical needs, it is necessary to develop a DIR method that can achieve fast computational speed and high registration accuracy simultaneously.…”