Novel CT-Based Objective Imaging Biomarkers of Long-Term Radiation-Induced Lung Damage

Veiga, Catarina; Landau, David; Devaraj, Anand; Doel, Tom; White, Jared; Ngai, Yenting; Hawkes, David J.; McClelland, Jamie R.

doi:10.1016/j.ijrobp.2018.06.006

Cited by 7 publications

(12 citation statements)

References 37 publications

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“…We recently developed a suite of twelve semi-automated, quantitative CT-based biomarkers of RILD to measure common post-RT radiological findings (parenchymal, pleural and lung volume changes) [15] , [20] . The biomarkers provide a detailed, continuous description of RILD well beyond commonly used local density changes in the lung parenchyma [14] , [18] , [30] , [31] , [32] , [33] , [34] , [35] .…”

Section: Methodsmentioning

confidence: 99%

“…The biomarkers provide a detailed, continuous description of RILD well beyond commonly used local density changes in the lung parenchyma [14] , [18] , [30] , [31] , [32] , [33] , [34] , [35] . Table 2 summarises the calculated measures; details on implementation, evaluation and limitations have been previously described [15] . Briefly, CT images acquired pre- and post-RT are rigidly aligned.…”

Section: Methodsmentioning

confidence: 99%

“… + [1] = dimensionless. § Definition was updated from the original publication [15] . $ For example, “Normal contralateral lung volume shrinkage” is defined as

.…”

Section: Methodsmentioning

confidence: 99%

“…Radiological findings provide critical information on the post-RT evolution of the respiratory system that is complementary to functional and symptomatic information. Imaging endpoints in particular allow the definition of objective measures that facilitate quantification and clinical correlation [3] , [13] , [14] , [15] , [16] , [17] , [18] . Thus, computed tomography (CT) imaging is commonly used to study RILD [8] , [19] , [20] .…”

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confidence: 99%

“…The aim of this study is to quantify the longitudinal evolution of RILD during the first 24-months after RT and correlate it with dosimetry and respiratory morbidity. We use clinical pulmonary functions tests (PFTs) together with a suite of novel quantitative CT-based measures [15] to describe the evolution of RILD. We expect our objective and comprehensive analysis to enrich our current understanding of how RILD develops and evolves, and to provide new insights that inform future, prospective studies of RILD.…”

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confidence: 99%

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Investigation of the evolution of radiation-induced lung damage using serial CT imaging and pulmonary function tests

Veiga

Chandy

Jacob

et al. 2020

Radiotherapy and Oncology

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Highlights Detailed RILD evolution described by objective radiological and pulmonary function measures. RILD is associated with volume loss of the treated lung and contralateral lung hyperinflation. Objective radiological findings might differentiate subjects with early versus late RILD. Most patients developed progressive lung damage, even when the early phase is absent/mild. Pre-RT lung function and RT dosimetry may identify subjects at increased risk of developing RILD.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“… + [1] = dimensionless. § Definition was updated from the original publication [15] . $ For example, “Normal contralateral lung volume shrinkage” is defined as

.…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Investigation of the evolution of radiation-induced lung damage using serial CT imaging and pulmonary function tests

Veiga

Chandy

Jacob

et al. 2020

Radiotherapy and Oncology

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Radiomics for Predicting Lung Cancer Outcomes Following Radiotherapy: A Systematic Review

et al. 2022

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Long-Term Results from the IDEAL-CRT Phase 1/2 Trial of Isotoxically Dose-Escalated Radiation Therapy and Concurrent Chemotherapy for Stage II/III Non-small Cell Lung Cancer

Fenwick

Landau

Baker

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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One-hundred eighteen patients with stage IIB-IV non-small cell lung cancer were treated with isotoxically escalated concurrent chemoradiation to median prescribed doses of 64.5 and 67.6 Gy in 30 fractions over 5 (n Z 36) or 6 weeks (n Z 82). Toxicity was acceptable for both schedules. Overall survival was longer in 6-week than in 5-week patients (median, 41.2 vs 22.1 months; hazard ratio, 0.56; 95% confidence interval, 0.32-0.98; P Z .04). Progression-free survival was also longer in 6-week patients (median, 21.1 vs 8.0 months; hazard ratio, 0.53; 95% confidence interval, 0.33-0.86; P Z .01).Purpose: The IDEAL-CRT phase 1/2 multicenter trial of isotoxically dose-escalated concurrent chemoradiation for stage II/III non-small cell lung cancer investigated two 30-fraction schedules of 5 and 6 weeks' duration. We report toxicity, tumor response, progression-free survival (PFS), and overall survival (OS) for both schedules, with long-term follow-up for the 6-week schedule. Methods and Materials: Patients received isotoxically individualized tumor radiation doses of 63 to 71 Gy in 5 weeks or 63 to 73 Gy in 6 weeks, delivered concurrently with 2 cycles of cisplatin and vinorelbine. Eligibility criteria were the same for both schedules.Results: One-hundred twenty patients (6% stage IIB, 68% IIIA, 26% IIIB, 1% IV) were recruited from 9 UK centers, 118 starting treatment. Median prescribed doses were 64.5 and 67.6 Gy for the 36 and 82 patients treated using the 5-and 6-week schedules. Grade 3 pneumonitis and early esophagitis rates were 3.4% and 5.9% overall and similar for each schedule individually. Late grade 2 esophageal toxicity occurred in 11.1% and 17.1% of 5-and 6-week patients. Grade 4 adverse events occurred in 17 (20.7%) 6-week patients but no 5-week patients. Four adverse events were grade 5, with 2 considered radiation therapy related. After median follow-up of 51.8 and 26.4 months for the 6-and 5-week schedules, median OS was 41.2 and 22.1 months, respectively, and median PFS was 21.1 and 8.0 months. In exploratory analyses, OS was significantly associated with schedule (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.32-0.98; P Z .04) and fractional clinical/internal target volume receiving 95% of the prescribed dose (HR, 0.88; 95% CI, 0.77-1.00; P Z .05). PFS was also significantly associated with schedule (HR, 0.53; 95% CI, 0.33-0.86; P Z .01). Conclusions: Toxicity in IDEAL-CRT was acceptable. Survival was promising for 6-week patients and significantly longer than for 5-week patients. Survival might be further lengthened by following the 6-week schedule with an immune agent, motivating further study of such combined optimized treatments.

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Novel CT-Based Objective Imaging Biomarkers of Long-Term Radiation-Induced Lung Damage

Abstract: We developed objective CT-based imaging biomarkers that quantify the severity of radiologic lung damage after radiation therapy. These biomarkers are representative of typical radiologic findings of RILD.

Cited by 7 publications

References 37 publications

Investigation of the evolution of radiation-induced lung damage using serial CT imaging and pulmonary function tests

Investigation of the evolution of radiation-induced lung damage using serial CT imaging and pulmonary function tests

Radiomics for Predicting Lung Cancer Outcomes Following Radiotherapy: A Systematic Review

Long-Term Results from the IDEAL-CRT Phase 1/2 Trial of Isotoxically Dose-Escalated Radiation Therapy and Concurrent Chemotherapy for Stage II/III Non-small Cell Lung Cancer

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