Modeling Patient-Specific Dose-Function Response for Enhanced Characterization of Personalized Functional Damage

Owen, D.; Boonstra, Phillip; Viglianti, Benjamin L.; Balter, James M.; Schipper, Matthew J.; Jackson, Will; Naqa, Issam El; Jolly, Shruti; Haken, R.K. Ten; Kong, Feng-Ming; Matuszak, Martha M.

doi:10.1016/j.ijrobp.2018.05.049

Cited by 8 publications

(5 citation statements)

References 53 publications

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“…Regional post-RT ventilation values might be lower because of the radiation-induced damage in the lung tissue. Several authors have investigated the dose-effect relation between the local dose and the relative perfusion/ventilation reduction after SAbR and conventional RT (Zhang et al 2010, Scheenstra et al 2013, Meng et al 2014, Avanzo et al 2015, Owen et al 2018. However, in this work we focused on the airway contribution to the preserved ventilation.…”

Section: Discussionmentioning

confidence: 99%

Functionally weighted airway sparing (FWAS): a functional avoidance method for preserving post-treatment ventilation in lung radiotherapy

et al. 2020

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Recent changes to the guidelines for screening and early diagnosis of lung cancer have increased the interest in preserving post-radiotherapy lung function. Current investigational approaches are based on spatially mapping functional regions and generating regional avoidance plans that preferentially spare highly ventilated/perfused lung. A potentially critical, yet overlooked, aspect of functional avoidance is radiation injury to peripheral airways, which serve as gas conduits to and from functional lung regions. Dose redistribution based solely on regional function may cause irreparable damage to the ‘supply chain’. To address this deficiency, we propose the functionally weighted airway sparing (FWAS) method. FWAS (i) maps the bronchial pathways to each functional sub-lobar lung volume; (ii) assigns a weighting factor to each airway based on the relative contribution of the sub-volume to overall lung function; and (iii) creates a treatment plan that aims to preserve these functional pathways. To evaluate it, we used four cases from a retrospective cohort of SAbR patients treated for lung cancer. Each patient’s airways were auto-segmented from a diagnostic-quality breath-hold CT using a research virtual bronchoscopy software. A ventilation map was generated from the planning 4DCT to map regional lung function. For each terminal airway, as resolved by the segmentation software, the total ventilation within the sub-lobar volume supported by that airway was estimated and used as a function-based weighting factor. Upstream airways were weighted based on the cumulative volumetric ventilation supported by corresponding downstream airways. Using a previously developed model for airway radiosensitivity, dose constraints were determined for each airway corresponding to a <5% probability of airway collapse. Airway dose constraints, ventilation scores, and clinical dose constraints were input to a swarm optimization–based inverse planning engine to create a 3D conformal SAbR plan (CRT). The FWAS plans were compared to the patients’ prescribed CRT clinical plans and the inverse-optimized clinical plans. Depending on the size and location of the tumour, the FWAS plan showed superior preservation of ventilation due to airflow preservation through open pathways (i.e. cumulative ventilation score from the sub-lobar volumes of open pathways). Improvements ranged between 3% and 23%, when comparing to the prescribed clinical plans, and between 3% and 35%, when comparing to the inverse-optimized clinical plans. The three plans satisfied clinical requirements for PTV coverage and OAR dose constraints. These initial results suggest that by sparing pathways to high-functioning lung subregions it is possible to reduce post-SAbR loss of respiratory function.

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Section: Discussionmentioning

confidence: 99%

Functionally weighted airway sparing (FWAS): a functional avoidance method for preserving post-treatment ventilation in lung radiotherapy

et al. 2020

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“…Various studies have reported on the timedependent reduction in the normal lung, 29,30 in which functional damage occurs at a higher rate in HF lungs. 31 Moreover, many studies have reported that a dose to a higher percent of functional intensity is associated with RILT. 32 Although normal lung doses should clearly be kept to a minimum to reduce functional damage, measuring the fraction of V/Q intensity receiving !20 Gy, in theory, only significantly differs from V 20 in patients with heterogeneous lung function.…”

Section: Discussionmentioning

confidence: 99%

Investigating the SPECT Dose-Function Metrics Associated With Radiation-Induced Lung Toxicity Risk in Patients With Non-small Cell Lung Cancer Undergoing Radiation Therapy

Owen

Sun

Boonstra

et al. 2021

Advances in Radiation Oncology

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Dose to normal lung has commonly been linked with radiation-induced lung toxicity (RILT) risk, but incorporating functional lung metrics in treatment planning may help further optimize dose delivery and reduce RILT incidence. The purpose of this study was to investigate the impact of the dose delivered to functional lung regions by analyzing perfusion (Q), ventilation (V), and combined V/Q single-photon-emission computed tomography (SPECT) dose-function metrics with regard to RILT risk in patients with non-small cell lung cancer (NSCLC) patients who received radiation therapy (RT). Methods and Materials: SPECT images acquired from 88 patients with locally advanced NSCLC before undergoing conventionally fractionated RT were retrospectively analyzed. Dose was converted to the nominal dose equivalent per 2 Gy fraction, and SPECT intensities were normalized. Regional lung segments were defined, and the average dose delivered to each lung region was quantified. Three functional categorizations were defined to represent low-, normal-, and high-functioning lungs. The percent of functional lung category receiving !20 Gy and mean functional intensity receiving !20 Gy (iV 20 ) were calculated. RILT was defined as grade 2þ radiation pneumonitis and/or clinical radiation fibrosis. A logistic regression was used to evaluate the association between dosefunction metrics and risk of RILT.

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“…However, radiotherapy also involves limitations comprising radio-induced toxicities on healthy surrounding tissues and an increase in the risk of developing radio-induced cancer following an exposition to a high dose of radiation [ 10 , 11 ]. Moreover, radiotherapy remains limited for tumors difficult to target or those requiring high doses of radiation, such as radioresistant cancers, which often leads to decreased therapeutic outcomes and cancer reoccurrence [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of core-shell Fe3O4@Au nanoparticles as radioenhancer in A549 cell lung cancer model

Slama,

Arcambal,

Septembre-Malaterre

et al. 2024

Heliyon

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Modeling Patient-Specific Dose-Function Response for Enhanced Characterization of Personalized Functional Damage

Cited by 8 publications

References 53 publications

Functionally weighted airway sparing (FWAS): a functional avoidance method for preserving post-treatment ventilation in lung radiotherapy

Functionally weighted airway sparing (FWAS): a functional avoidance method for preserving post-treatment ventilation in lung radiotherapy

Investigating the SPECT Dose-Function Metrics Associated With Radiation-Induced Lung Toxicity Risk in Patients With Non-small Cell Lung Cancer Undergoing Radiation Therapy

Evaluation of core-shell Fe3O4@Au nanoparticles as radioenhancer in A549 cell lung cancer model

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