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

PURPOSE: 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 do...

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Autores principales: Owen, Daniel R., Sun, Yilun, Boonstra, Philip S., McFarlane, Matthew, Viglianti, Benjamin L., Balter, James M., El Naqa, Issam, Schipper, Matthew J., Schonewolf, Caitlin A., Ten Haken, Randall K., Kong, Feng-Ming S., Jolly, Shruti, Matuszak, Martha M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010578/
https://www.ncbi.nlm.nih.gov/pubmed/33817412
http://dx.doi.org/10.1016/j.adro.2021.100666
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author Owen, Daniel R.
Sun, Yilun
Boonstra, Philip S.
McFarlane, Matthew
Viglianti, Benjamin L.
Balter, James M.
El Naqa, Issam
Schipper, Matthew J.
Schonewolf, Caitlin A.
Ten Haken, Randall K.
Kong, Feng-Ming S.
Jolly, Shruti
Matuszak, Martha M.
author_facet Owen, Daniel R.
Sun, Yilun
Boonstra, Philip S.
McFarlane, Matthew
Viglianti, Benjamin L.
Balter, James M.
El Naqa, Issam
Schipper, Matthew J.
Schonewolf, Caitlin A.
Ten Haken, Randall K.
Kong, Feng-Ming S.
Jolly, Shruti
Matuszak, Martha M.
author_sort Owen, Daniel R.
collection PubMed
description PURPOSE: 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 2+ radiation pneumonitis and/or clinical radiation fibrosis. A logistic regression was used to evaluate the association between dose-function metrics and risk of RILT. RESULTS: By analyzing V/Q normalized intensities and functional distributions across the population, a wide range in functional capability (especially in the ipsilateral lung) was observed in patients with NSCLC before RT. Through multivariable regression models, global lung average dose to the lower lung was found to be significantly associated with RILT, and Q and V iV(20) were correlated with RILT when using ipsilateral lung metrics. Through a receiver operating characteristic analysis, combined V/Q low-function receiving ≥20 Gy (low-functioning V/Q(20)) in the ipsilateral lung was found to be the best predictor (area under the curce: 0.79) of RILT risk. CONCLUSIONS: Irradiation of the inferior lung appears to be a locational sensitivity for RILT risk. The multivariable correlation between ipsilateral lung iV(20) and RILT, as well as the association of low-functioning V/Q(20) and RILT, suggest that irradiating low-functioning regions in the lung may lead to higher toxicity rates.
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spelling pubmed-80105782021-04-02 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, Daniel R. Sun, Yilun Boonstra, Philip S. McFarlane, Matthew Viglianti, Benjamin L. Balter, James M. El Naqa, Issam Schipper, Matthew J. Schonewolf, Caitlin A. Ten Haken, Randall K. Kong, Feng-Ming S. Jolly, Shruti Matuszak, Martha M. Adv Radiat Oncol Scientific Article PURPOSE: 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 2+ radiation pneumonitis and/or clinical radiation fibrosis. A logistic regression was used to evaluate the association between dose-function metrics and risk of RILT. RESULTS: By analyzing V/Q normalized intensities and functional distributions across the population, a wide range in functional capability (especially in the ipsilateral lung) was observed in patients with NSCLC before RT. Through multivariable regression models, global lung average dose to the lower lung was found to be significantly associated with RILT, and Q and V iV(20) were correlated with RILT when using ipsilateral lung metrics. Through a receiver operating characteristic analysis, combined V/Q low-function receiving ≥20 Gy (low-functioning V/Q(20)) in the ipsilateral lung was found to be the best predictor (area under the curce: 0.79) of RILT risk. CONCLUSIONS: Irradiation of the inferior lung appears to be a locational sensitivity for RILT risk. The multivariable correlation between ipsilateral lung iV(20) and RILT, as well as the association of low-functioning V/Q(20) and RILT, suggest that irradiating low-functioning regions in the lung may lead to higher toxicity rates. Elsevier 2021-02-07 /pmc/articles/PMC8010578/ /pubmed/33817412 http://dx.doi.org/10.1016/j.adro.2021.100666 Text en © 2021 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Scientific Article
Owen, Daniel R.
Sun, Yilun
Boonstra, Philip S.
McFarlane, Matthew
Viglianti, Benjamin L.
Balter, James M.
El Naqa, Issam
Schipper, Matthew J.
Schonewolf, Caitlin A.
Ten Haken, Randall K.
Kong, Feng-Ming S.
Jolly, Shruti
Matuszak, Martha M.
Investigating the SPECT Dose-Function Metrics Associated With Radiation-Induced Lung Toxicity Risk in Patients With Non-small Cell Lung Cancer Undergoing Radiation Therapy
title Investigating the SPECT Dose-Function Metrics Associated With Radiation-Induced Lung Toxicity Risk in Patients With Non-small Cell Lung Cancer Undergoing Radiation Therapy
title_full Investigating the SPECT Dose-Function Metrics Associated With Radiation-Induced Lung Toxicity Risk in Patients With Non-small Cell Lung Cancer Undergoing Radiation Therapy
title_fullStr Investigating the SPECT Dose-Function Metrics Associated With Radiation-Induced Lung Toxicity Risk in Patients With Non-small Cell Lung Cancer Undergoing Radiation Therapy
title_full_unstemmed Investigating the SPECT Dose-Function Metrics Associated With Radiation-Induced Lung Toxicity Risk in Patients With Non-small Cell Lung Cancer Undergoing Radiation Therapy
title_short Investigating the SPECT Dose-Function Metrics Associated With Radiation-Induced Lung Toxicity Risk in Patients With Non-small Cell Lung Cancer Undergoing Radiation Therapy
title_sort investigating the spect dose-function metrics associated with radiation-induced lung toxicity risk in patients with non-small cell lung cancer undergoing radiation therapy
topic Scientific Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010578/
https://www.ncbi.nlm.nih.gov/pubmed/33817412
http://dx.doi.org/10.1016/j.adro.2021.100666
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