Daily Image Guidance With Cone Beam Computed Tomography May Reduce Radiation Pneumonitis in Unresectable Non-Small Cell Lung Cancer

Yegya-Raman, Nikhil; Kim, Sinae; Deek, Matthew P.; Li, Diana; Gupta, Apar; Bond, Laura; Dwivedi, Abhishek; Braver, Joel K.; Reyhan, Meral; Mittal, Anmol; Gui, B.; Malhotra, Jyoti; Aisner, Joseph; Jabbour, Salma K.

doi:10.1016/j.ijrobp.2018.03.025

Cited by 23 publications

(9 citation statements)

References 26 publications

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“…In addition to advanced RT plans, hypo-RT increases the accuracy requirements for the delivery of radiation [ 29 ]. IGRT is considered as a good strategy to address this issue and has been associated with a lower risk of radiation pneumonitis [ 30 ]. In our study, daily megavolt CT in tomotherapy was performed to ensure the precise delivery of radiation.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Image-Guided Moderately Hypofractionated Radiotherapy for Stage III Non-Small-Cell Lung Cancer

Zhang

Chen

et al. 2021

Journal of Oncology

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Objective. To evaluate the efficacy and toxicity of hypofractionated radiotherapy (hypo-RT) for stage III non-small-cell lung cancer (NSCLC) in the Chinese population. Methods. Eighty-six stage III NSCLC patients who received hypo-RT (60 Gy/20 fractions, BED = 78.00 Gy: 73 patients; 62.5 Gy/25 fractions, BED = 78.13 Gy: 13 patients) were recruited. Fifty-seven patients who received conventional radiotherapy (60 Gy/30 fractions, BED = 72.00 Gy) during the same period were enrolled as the control group. All hypo-RT treatments were conducted using image-guided technology. The efficacy and toxicity of the treatment were compared between the two groups. Results. The median duration of follow-up was 23.0 months (range: 4.0–82.0 months). Univariate and multivariate analyses of all 143 stage III NSCLC patients revealed that hypo-RT was an independent factor for progression-free survival (PFS) and overall survival (OS). The median PFS and OS of hypo-RT were significantly higher than in the conventional RT group (PFS: 14.30, 11.00 months, p = 0.035 ; OS: 43.30, 31.50 months, p = 0.045 ). The incidence rates of symptomatic radiation pneumonitis and radiation esophagitis (≥grade 2) were 17.77% and 27.91%, respectively, in the hypo-RT group. Compared to the conventional radiation therapy group (22.81% and 19.30%, respectively), no significant differences were found between the two common side effects ( p = 0.662 and p = 0.241 , respectively). Conclusion. For Chinese stage III NSCLC patients, image-guided hypo-RT offers favorable prognosis, and the treatment toxicity was totally acceptable. This radiation modality deserves further prospective clinical trials.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Image-Guided Moderately Hypofractionated Radiotherapy for Stage III Non-Small-Cell Lung Cancer

Zhang

Chen

et al. 2021

Journal of Oncology

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“…On-board free-breathing cone beam computed tomography (CBCT) is a useful tool for the target localization of lung tumors ( 16 , 17 ). The use of CBCT provides a guarantee of precise irradiation during treatment with lung SBRT.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Lung Tumor Target Volume in a Large Sample: Target and Clinical Factors Influencing the Volume Derived From Four-Dimensional CT and Cone Beam CT

Zhang

Sun

et al. 2022

Front. Oncol.

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Background and PurposeThis study aimed to systematically evaluate the influence of target-related and clinical factors on volume differences and the similarity of targets derived from four-dimensional computed tomography (4DCT) and cone beam computed tomography (CBCT) images in lung stereotactic body radiation therapy (SBRT).Materials and Methods4DCT and CBCT image data of 210 tumors from 195 patients were analyzed. The internal gross target volume (IGTV) derived from the maximum intensity projection (MIP) of 4DCT (IGTV-MIP) and the IGTV from CBCT (IGTV-CBCT) were compared with the reference IGTV from 10 phases of 4DCT (IGTV-10). The target size, tumor motion, and the similarity between IGTVs were measured. The influence of target-related and clinical factors on the adequacy of IGTVs derived from 4DCT MIP and CBCT images was evaluated.ResultsThe mean tumor motion amplitude in the 3D direction was 6.5 ± 5 mm. The mean size ratio of IGTV-CBCT and IGTV-MIP compared to IGTV-10 in all patients was 0.71 ± 0.21 and 0.8 ± 0.14, respectively. Female sex, greater BSA, and larger target size were protective factors, while the Karnofsky Performance Status, body mass index, and motion were risk factors for the similarity between IGTV-MIP and IGTV-10. Older age and larger target size were protective factors, while adhesion to the heart, coexistence with cardiopathy, and tumor motion were risk factors for the similarity between IGTV-CBCT and IGTV-10.ConclusionClinical factors should be considered when using MIP images for defining ITV, and when using CBCT images for verifying treatment targets.

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“…IGRT can verify the treatment position prior to the implementation of the treatment, measure and analyze the three-dimensional error of the central position of tumors and correct it online, which has become one of the important bases for the implementation of precision therapy [17]. In the system of IGRT, CBCT has attracted significant attention from practitioners who seek to enhance diagnosis and treatment for their patients because it provides multidimensional and dimensionally accurate images for diagnosis and treatment planning [18] However, CBCT is a conical beam scanning, and has a certain gap between fan Beam CT in the image clarity, especially for lung tumors with obvious respiration problems [19]. Therefore, how to quickly and accurately register CBCT images with planned images, especially for chest tumors that are easily affected by respiration, needs a further investigation.…”

Section: Methodsmentioning

confidence: 99%

Comparative evaluation of image registration methods with different interest regions in lung cancer radiotherapy

et al. 2019

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Background: Lung cancer is a leading cause of morbidity and mortality worldwide. Radiotherapy for lung cancer is beneficial in both the radical and palliative settings, and technologic advances in recent years now afford an opportunity for this treatment to be more targeted than ever before. Although the delivery of more accurate forms of radiotherapy has minimized the risks of side-effects, how to utilize this treatment to optimize outcomes remains questionable. This study aimed to evaluate the accuracy of cone beam computed tomography (CBCT) image registration used in image-guided radiotherapy, providing reasonable guidance for clinic application of CBCT in lung cancer. Methods: A total of 53 patients with lung carcinoma including 34 central and 19 peripheral lesions were collected in this study. Varian-IX linear accelerator on-board imaging (OBI) system was used to acquire CBCT scans in threedimensional (3D) conformal radiotherapy before delivery. Different regions (whole lung/target/vertebrae/ipsilateral structure) were manually registered, and the position deviation and the registration time were analyzed. Results: It was suggested that 34 cases belonged to central type and 19 cases belonged to peripheral type. The volume of left lung and right lung was 1242.98 ± 452.46 cc, 1689.69 ± 574.31 cc, respectively. Tumor size was 6.65 ± 3.87 cm in diameter, and 129.67 ± 136.48 cc in volume. The percentage of left lung and right lung was 6.17 ± 1.24%, 4.74 ± 0.38%, respectively. The position deviation value and absolute value of image registration methods of X, Y and Z axis were not significant (P > 0.05). However, registration time (s) between whole lung registration group, tumor registration group, vertebral body registration group, affected lung registration group, and artificial registration group, was 3.651 ± 0.867 s, 1.144 ± 0.129 s, 1.226 ± 0.126 s, 2.081 ± 0.427 s, 179.491 ± 71.975 s, respectively. The differences were significant (P < 0.05). The registration differences between small tumor group and large tumor group were not statistically significant (P > 0.05). Conclusion: The automatic image matching of OBI is accuracy and high reliability in recognition of offset error. Registering body or ipsilateral structure is recommended to be used in CBCT for lung cancer.

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Daily Image Guidance With Cone Beam Computed Tomography May Reduce Radiation Pneumonitis in Unresectable Non-Small Cell Lung Cancer

Cited by 23 publications

References 26 publications

Outcomes of Image-Guided Moderately Hypofractionated Radiotherapy for Stage III Non-Small-Cell Lung Cancer

Outcomes of Image-Guided Moderately Hypofractionated Radiotherapy for Stage III Non-Small-Cell Lung Cancer

Evaluation of Lung Tumor Target Volume in a Large Sample: Target and Clinical Factors Influencing the Volume Derived From Four-Dimensional CT and Cone Beam CT

Comparative evaluation of image registration methods with different interest regions in lung cancer radiotherapy

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