In Silico Ventilation Within the Dose-Volume is Predictive of Lung Function Post-radiation Therapy in Patients with Lung Cancer

Abstract

Lung cancer is a leading cause of death worldwide. Radiation therapy (RT) is one method to treat this disease. A common side effect of RT for lung cancer is radiation-induced lung damage (RILD) which leads to loss of lung function. RILD often compounds pre-existing smoking-related regional lung function impairment. It is difficult to predict patient outcomes due to large variability in individual response to RT. In this study, the capability of image-based modelling of regional ventilation in lung cancer patients to predict lung function post-RT was investigated. Twenty-five patient-based models were created using CT images to define the airway geometry, size and location of tumour, and distribution of emphysema. Simulated ventilation within the 20 Gy isodose volume showed a statistically significant negative correlation with the change in forced expiratory volume in 1 s 12-months post-RT (p = 0.001, R = − 0.61). Patients with higher simulated ventilation within the 20 Gy isodose volume had a greater loss in lung function post-RT and vice versa. This relationship was only evident with the combined impact of tumour and emphysema, with the location of the emphysema relative to the dose-volume being important. Our results suggest that model-based ventilation measures can be used in the prediction of patient lung function post-RT.

International expert consensus on diagnosis and treatment of lung cancer complicated by chronic obstructive pulmonary disease

“…The risks and benefits of radiotherapy should be carefully weighed. In addition, multiparameter models for prediction ( 239 ) as well as imaging techniques including perfusion imaging, functional imaging, and 4D-CT ( 256 , 257 ) can be used to guide the radiotherapy-field setting and dose restriction, which may in turn further reduce radiotherapy-related lung injury.…”

Analyzing lung cancer risks in patients with impaired pulmonary function through characterization of gut microbiome and metabolites

“…Kachuri et al found that immune-mediated genetic pathways led to impaired lung function, with reduced FEV1 increasing the risk of squamous cell carcinoma and reduced FEV1/FVC increasing the risk of adenocarcinoma [ 13 ]. A large observational literature has found an increased risk of LC in patients with pulmonary insufficiency [ 14 ], but the possible relationship between LC and respiratory dysfunction has not been established. Li et al revealed that the diversity of pulmonary microbiota in chronic obstructive pulmonary disease (COPD) patients with impaired lung function was similar [ 15 ].…”