Is it Possible to Achieve more Accurate Mediastinal Nodal Radiotherapy Planning for NSCLC with PET/CT?

Şimşek, Fikri Selçuk; Koroglu, Reyhan; Elmalı, Ferhan; Comak, Aylin; Ulutaş, Hakkı; Balcı, Tansel Ansal; Aşik, Muhammed; Akatli, Aysenur; Kekilli, Ersoy; Oner, Ali Ozan

doi:10.5455/jpma.296815

Cited by 2 publications

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“…In the process of treatment, radiation can directly damage the vascular endothelial cells and parenchymal cells of the lung, cause inflammatory changes, promote the continuous activation of stromal cells, and lead to irreversible pulmonary fibrosis injury[ 5 ]. It may not only affect the smooth implementation of the treatment plan and reduce treatment efficacy, but also increase pain and seriously reduce quality of life of cancer patients[ 6 , 7 ]. Radiation pneumonitis is a common complication of radiotherapy for thoracic tumors, and is mainly caused by radiation-induced damage to the pulmonary vascular endothelial cells and parenchymal cells.…”

Section: Introductionmentioning

confidence: 99%

Multiple regression analysis of risk factors related to radiation pneumonitis

Shi¹,

Yang²,

Yao³

2023

World J Clin Cases

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BACKGROUND Radiation pneumonitis (RP) is a severe complication of thoracic radiotherapy that may lead to dyspnea and lung fibrosis, and negatively affects patients’ quality of life. AIM To carry out multiple regression analysis on the influencing factors of radiation pneumonitis. METHODS Records of 234 patients receiving chest radiotherapy in Huzhou Central Hospital (Huzhou, Zhejiang Province, China) from January 2018 to February 2021, and the patients were divided into either a study group or a control group based on the presence of radiation pneumonitis or not. Among them, 93 patients with radiation pneumonitis were included in the study group and 141 without radiation pneumonitis were included in the control group. General characteristics, and radiation and imaging examination data of the two groups were collected and compared. Due to the statistical significance observed, multiple regression analysis was performed on age, tumor type, chemotherapy history, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), carbon monoxide diffusion volume (DLCO), FEV1/FVC ratio, planned target area (PTV), mean lung dose (MLD), total number of radiation fields, percentage of lung tissue in total lung volume (vdose), probability of normal tissue complications (NTCP), and other factors. RESULTS The proportions of patients aged ≥ 60 years and those with the diagnosis of lung cancer and a history of chemotherapy in the study group were higher than those in the control group ( P < 0.05); FEV1, DLCO, and FEV1/FVC ratio in the study group were lower than those in the control group ( P < 0.05), while PTV, MLD, total field number, vdose, and NTCP were higher than in the control group ( P < 0.05). Logistic regression analysis showed that age, lung cancer diagnosis, chemotherapy history, FEV1, FEV1/FVC ratio, PTV, MLD, total number of radiation fields, vdose, and NTCP were risk factors for radiation pneumonitis. CONCLUSION We have identified patient age, type of lung cancer, history of chemotherapy, lung function, and radiotherapy parameters as risk factors for radiation pneumonitis. Comprehensive evaluation and examination should be carried out before radiotherapy to effectively prevent radiation pneumonitis.

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Section: Introductionmentioning

confidence: 99%

Multiple regression analysis of risk factors related to radiation pneumonitis

Shi¹,

Yang²,

Yao³

2023

World J Clin Cases

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“…Technological improvements in recent years have enabled dose escalation with better tumor coverage and optimized sparing of normal tissues, resulting in a survival advantage with lower toxicity [ 8 – 10 ]. These techniques include intensity-modulated radiotherapy, adaptive image-guided radiotherapy and the use of 18 F-FDG PET/CT in radiation planning [ 11 , 12 ]. In particular, information on metabolism provided by 18 F-FDG PET/CT can improve target volume definition and dose planning before and during radiotherapy (RT), enabling better selection of patients and individualization of therapeutic strategies [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

PET/CT-based adaptive radiotherapy of locally advanced non-small cell lung cancer in multicenter yDEGRO ARO 2017-01 cohort study

et al. 2022

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Background Stage III non-small cell lung cancer (NSCLC) represents a highly heterogeneous disease and treatment burden. Advances in imaging modality show promising results for radiotherapy planning. In this multicentric study, we evaluated the impact of PET/CT-based radiotherapy planning on the prognosis of patients with stage III NSCLC. Method and patients A retrospective observational cohort study (ARO 2017-01/NCT03055715) was conducted by the young DEGRO trial group of the German Society for Radiation Oncology (DEGRO) with the primary objective to assess the effect of tumour volume change during chemoradiotherapy and the secondary objective to assess the effect of treatment planning on survival. Three hundred forty-seven patients with stage III NSCLC treated at 21 university centers between January 2010 and December 2013 were enrolled in this trial. Patients received primary curative chemoradiotherapy with an intended dose of 50 Gy (hypofractionated) or > 60 Gy (normofractionated). To assess the effect of radiotherapy planning modality on overall survival, we used multivariate frailty models. Models were adjusted for gross tumor volume at the initiation of therapy, age, sex, simultaneous chemotherapy, lung comorbidities, RT dose and tumor grade. By considering the random effect, we can account for heterogeneity in survival and considered covariates within the model in relation to the study side. Results Patients were predominantly male (n = 269, 78.4%) with mainly adenocarcinoma (56.4%) and an average of 67.2 years. Adaptation of radiotherapy with consecutive reduction of irradiation volume showed no significant disadvantage for patient survival (HR = 1.21, 95% CI 0.89–1.64). The use of PET/CT co-registration in radiation planning tended to result in better oncologic outcomes, although no significant association could be shown (HR = 0.8, 95% CI 0.56–1.16). Centers with a consistent planning strategy performed better than those without a preferred planning method (0.62, 95% CI 0.41–0.94). Conclusion A consistent planning strategy has positive effects on overall survival. The use of PET/CT-based adaptive radiotherapy planning shows a similar survival prospect with the prospective of lower treatment volumes. In future research, toxicities need to be analysed in order to assess such reasoning.

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Is it Possible to Achieve more Accurate Mediastinal Nodal Radiotherapy Planning for NSCLC with PET/CT?

Cited by 2 publications

References 0 publications

Multiple regression analysis of risk factors related to radiation pneumonitis

Multiple regression analysis of risk factors related to radiation pneumonitis

PET/CT-based adaptive radiotherapy of locally advanced non-small cell lung cancer in multicenter yDEGRO ARO 2017-01 cohort study

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