Functional lung imaging in radiation therapy for lung cancer: A systematic review and meta-analysis

Bucknell, Nicholas; Hardcastle, Nicholas; Bressel, Mathias; Hofman, Michael S; Kron, Tomas; Ball, David; Siva, Shankar

doi:10.1016/j.radonc.2018.07.014

Cited by 59 publications

(81 citation statements)

References 117 publications

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“…Our results are consistent with the recent systematic review and meta-analysis on functional lung imaging potential in RT planning conducted by Bucknell et al [12]. With the plans optimised to spare functional lung, the authors report mean functional V 20 reduced by 4.2% (95% CI: 2.3; 6.0), and MLD by 2.2 Gy (95% CI: 1.2; 3.3) when plans were optimised to spare functional lung.…”

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

“…Several planning studies sparing highly functional lung regions for radiation have been conducted [12][13][14][15][16][17][18][19][20]. In these studies, various functional imaging modalities have been used to target perfusion, ventilation or both [12,21]. In one of the earlier attempts to incorporate SPECT functional lung imaging into IMRT for non-small cell lung cancer from Royal Marsden, UK, the authors demonstrated that incorporation of functional information into standard anatomical 3DCRT or IMRT planning can allow reductions in the dose to the functional lung [17,19,20].…”

Section: Discussionmentioning

confidence: 99%

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Functional perfusion image guided radiation treatment planning for locally advanced lung cancer

Farr

West

Yeghiaian-Alvandi

et al. 2019

Physics and Imaging in Radiation Oncology

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Background and purpose: Functional avoidance radiation therapy (RT) aims at sparing functional lung regions. The purpose of this simulation study was to evaluate the feasibility of functional lung avoidance methodology in RT of lung cancer and to characterize the achievable dosimetry of single photon emission computed tomography (SPECT) guided treatment planning. Materials and methods: Fifteen consecutive lung cancer patients were included and planned for definitive RT of 60-66 Gy in 2-Gy fractions. Two plans were optimized: a standard CT-plan, and functional SPECT-plan. The objective was to reduce dose to the highly functional lung subvolumes without compromising tumour coverage, and respecting dose to other organs at risk. For each patient a 3D-conformal, intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy plans were created for standard and functional avoidance. Standard versus functional dose-volume parameters for functional lung (FL) subvolumes, organs at risk and tumour coverage were compared. Results: The largest dose reduction was achieved with IMRT plans. Functional plans resulted in dose reduction from 9.0 Gy to 6.7 Gy (mean reduction of 2.3 Gy or 26%) to the highest functional subvolume FL80% (95%CI 1.1; 3.5). Dose to FL40% was reduced from 13.3 Gy to 11.6 Gy with functional planning. Dose reduction to FL40% was 1.7 Gy (95%CI 0.9; 2.6). Functional volume of lung receiving over 20 Gy improved by 5% (standard 22%, functional 17%). Dose to organs at risk and tumour coverage were not significantly different between plans. Conclusions: SPECT/CT-guided planning resulted in improved dose-volumetric outcomes for functional lung. This methodology may lead to potential reduction in radiation-induced lung toxicity.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Functional perfusion image guided radiation treatment planning for locally advanced lung cancer

Farr

West

Yeghiaian-Alvandi

et al. 2019

Physics and Imaging in Radiation Oncology

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“…In agreement with the findings of the present study, a large number of studies showed that dosimetric parameters of radiotherapy were related to the risk of radiation-induced lung injury 14,15 . We found that the patients treated with prescription dose higher than 62 Gy or mean lung dose higher than 17.4 Gy were more likely to suffer from ARP.…”

Section: Discussionsupporting

confidence: 93%

The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy

Wang

Huo

et al. 2020

Sci Rep

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Acute Radiation Pneumonitis (ARP) is one of the most common dose-limiting toxicities of thoracic radiotherapy. The accurate diagnosis of ARP remains a challenge because of the lack of a rapid biomarker capable of differentiating ARP from bacterial pneumo (BP). The aim of this study was to investigate the potential usefulness of procalcitonin (PCT) in the differential diagnosis of ARP and BP. Lung cancer patients who had undergone thoracic radiotherapy within 6 months and were admitted to hospital for ARP or BP were retrospectively analyzed. The serum levels of PCT, C-reactive protein (CRP) and white blood cells (WBC) were compared between the two groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic value of PCT, CRP and WBC in the differential diagnosis of ARP and BP and determine the best cutoff values. One hundred eighteen patients were included. Among them, seventy-seven patients were diagnosed with ARP, and 41 patients were diagnosed with BP. The PCT concentrations for patients diagnosed with ARP group were significantly lower than those in the BP group (P < 0.001). There were no differences in CRP and WBC between the two groups. The areas under the ROC curves (AUC) for PCT, CRP and WBC were 0.745, 0.589 and 0.578, respectively. The best cutoff values of PCT, CRP and WBC were 0.47 μg/L, 54.5 mg/L and 9.9 × 10 9 /L, respectively. Low serum PCT levels are associated with ARP. PCT is a useful biomarker to distinguish ARP from BP. Radiotherapy has been widely used for the curative and palliative treatment of lung cancer. Radiation-induced lung injury (RILI) is the most common dose-limiting toxicity of thoracic radiotherapy 1. RILI includes acute radiation pneumonitis (ARP) and pulmonary fibrosis. ARP often occurs about 1 to several months after radiotherapy. Commonly, ARP is relatively mild with patients, exhibiting no obvious symptoms except for imaging abnormalities. However, ARP can be a very serious event, especially after large volume radiotherapy. The incidence of grade 3-5 ARP can reach about 20% according to a recent study 2. When symptoms are more severe, patients cannot be managed as outpatients and require hospitalization. Continued progression of symptomatic ARP can cause respiratory failure and even death. Early and timely intervention can prevent the progression of ARP, improve patient symptoms, and potentially reduce post-radiation pulmonary fibrosis. However, accurate diagnosis of ARP remains difficult. The most important issue for radiation oncologists is to differentiate them from the bacterial pneumonia (BP) which are common in lung cancer patients 3. ARP and BP share many of the same symptoms such as cough and fever and both can be identified by changes in imaging. ARP can usually be identified by the positional relationship between the shapes of the radiation field and the

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“…Ding et al [20] found that 20% of the maximum SPECT count may be the optimal threshold to define the functional lung. The threshold is a tricky parameter ranging from 20% to 90%, of which 70% and 30% are the most common [21]. The other approach utilizes the weighting function based on functional images.…”

mentioning

confidence: 99%

A Unified Framework to Integrate SPECT Perfusion Imaging with Dose-volume Metrics for Estimation of Radiation Pneumonitis

Dai

Zheng

et al. 2020

Preprint

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Background: Single photon emission computed tomography (SPECT) images provides functional information in both diagnosis and radiation therapy. This study aimed to evaluate a unified framework of different approaches and find the optimal one in integrating SPECT lung perfusion imaging into radiotherapy to estimate radiation pneumonitis.Methods: Twenty-five patients with thoracic tumors were included in this study. All patients had SPECT perfusion imaging before radiotherapeutic treatment. The SPECT images were registered to the planning computed tomography (CT) via a rigid-body transformation. Then a unified framework was presented to integrate functional information with anatomical information to generate functional dose-volume parameters. The framework contained different mapping approaches using uniform, thresholding, linear or non-linear functions. To compare the different approaches in the unified framework, the ability of predicting lung toxicity outcome was evaluated via the receiver operating characteristic (ROC) curve analysis.Results: Functional dose-volume metrics defined using the linear function achieves the highest value of area under the curve (AUC), compared to those defined with the other three types of mapping functions. With the linear mapping function, significant factors for predicting radiation pneumonia (p < 0.05) includes the functional mean lung dose (fMLD) with the threshold of 50-100% and lung volume receiving more than 30 Gy dose (fV_30) with the threshold of 60-100%, among which fMLD showed the highest prediction accuracy (AUC=0.772, threshold=50-100%). Conclusions: We proposed a framework of functional dose-volume metrics to predict the outcome of radiation pneumonitis. The metrics using the linear function outperform the others.

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Functional lung imaging in radiation therapy for lung cancer: A systematic review and meta-analysis

Cited by 59 publications

References 117 publications

Functional perfusion image guided radiation treatment planning for locally advanced lung cancer

Functional perfusion image guided radiation treatment planning for locally advanced lung cancer

The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy

A Unified Framework to Integrate SPECT Perfusion Imaging with Dose-volume Metrics for Estimation of Radiation Pneumonitis

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