Can CBCT-Based Delta Radiomics Predict Normal Lung Toxicity during Thoracic Radiation?

Jose, N.; Varghese, A.J.; Thomas, H.M.; Irodi, A.; Paul, J.C.; Mathew, M.; Isiah, R.; John, S.; Godson, H.F.; Peace, T.B.; Pavamani, S.P.; Devadhas, D.; Sasidharan, B.K.

doi:10.1016/j.ijrobp.2022.07.934

Cited by 2 publications

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“…More clinical data would be required in larger institutions to establish a solid treatment strategy for early RP detection. Recently, Jose et al [ 15 ] proposed a machine learning algorithm for early RP detection using CBCT image-based delta radiomics. In the future, this technique may provide an automated method for detecting early RP more precisely during the course of radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Early Detection of Radiation Pneumonitis on Cone-Beam CT Images During a Course of Radiotherapy: A Case Series Report

Azumi¹,

Soyama²,

Saito³

2023

Cureus

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Background and aim Radiation pneumonitis (RP) is a critical pulmonary toxicity following dose delivery to the lung, and it is usually diagnosed after radiotherapy courses are completed. Because RP may result in a lethal complication, a practical method for detecting early-phase RP is awaited. In this article, we describe our experience through a variety of clinical cases and discuss treatment decisions and lessons we have made and learned. Materials and methods A daily cone-beam computed tomography (CBCT) scan was employed with a lung window setting to detect the early-phase RP during treatment courses. For the past five years, thirty patients were diagnosed with RP, and eight patients were detected during radiotherapy courses on the CBCT images. Our best efforts were made in detecting early ground-glass opacity and early RP on CBCT images prior to symptoms. The eight cases were described in more detail with CBCT or CT images. Results and discussion Initially, RP was detected at 50 Gy or greater. However, more careful CBCT observation resulted in earlier detection at around 40 Gy. Then, a new problem arose whether the treatment should be terminated. It was reported that early RP development was associated with higher-grade complications, and therefore it is preferable to terminate radiotherapy once we detect even early-phase RP. However, termination in the middle of the treatment course may significantly reduce the therapeutic effect. In our experience, patients with favorable clinical status may continue to receive radiotherapy with careful observation of lung parenchyma on CBCT images and clinical data, such as Krebs Von den Lungen-6 (KL-6) and C-reactive protein (CRP). Conclusion We have shown that early detection of RP may be feasible during radiotherapy courses by daily monitoring of CBCT lung images. Further studies are awaited to proceed.

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Section: Discussionmentioning

confidence: 99%