Characterizing Pulmonary Function Test Changes for Patients With Lung Cancer Treated on a 2-Institution, 4-Dimensional Computed Tomography-Ventilation Functional Avoidance Prospective Clinical Trial.
Characterizing Pulmonary Function Test Changes for Patients With Lung Cancer Treated on a 2-Institution, 4-Dimensional Computed Tomography-Ventilation Functional Avoidance Prospective Clinical Trial.
复制标题
DOI：
10.1016/j.adro.2022.101133
复制
发表时间：
2023-03
影响因子：
2.3
通讯作者：
Vinogradskiy, Yevgeniy
中科院分区：
文献类型：
--
作者：
Miller, Ryan;Castillo, Richard;Castillo, Edward;Jones, Bernard L;Miften, Moyed;Kavanagh, Brian;Lu, Bo;Werner-Wasik, Maria;Ghassemi, Nader;Lombardo, Joseph;Barta, Julie;Grills, Inga;Rusthoven, Chad G;Guerrero, Thomas;Vinogradskiy, Yevgeniy
四维计算机断层扫描 (4DCT)——基于通气的功能性回避使用 4DCT 图像来生成避开肺部功能区域的计划，以减少肺部毒性作用。一项 2 期、多中心、前瞻性研究已完成，以评估 4DCT 通气功能性避免放射治疗。本研究的目的是报告接受功能性避免放射治疗的患者治疗前至治疗后肺功能测试（PFT）变化的结果。收集了接受放化疗的局部晚期肺癌患者。生成了基于 4DCT 通气图像的功能性回避计划。 PFT 在基线和放化疗后 3 个月获得。报告了 PFT 指标的差异，包括一氧化碳扩散能力 (DLCO)、1 秒用力呼气量 (FEV1) 和用力肺活量 (FVC)。对经历过和未经历过 2 级或以上肺炎的患者的 PFT 指标进行了比较。参加该研究的 56 名患者的基线和治疗后 PFT 可评估用于分析。 DLCO、FEV1 和 FVC 的平均变化分别为 –11.6% ± 14.2%、–5.6% ± 16.9% 和 –9.0% ± 20.1%。 2 级或以上放射性肺炎患者的 DLCO 平均变化为 –15.4% ± 14.4%，<2 级放射性肺炎患者为 –10.8% ± 14.1% (P = .37)。 2 级或以上放射性肺炎患者的 FEV1 平均变化为 –14.3% ± 22.1%，<2 级放射性肺炎患者的 FEV1 平均变化为 –3.9% ± 15.4% (P = .09)。目前的工作是第一个定量描述接受前瞻性功能性避免放射治疗研究的肺癌患者 PFT 变化的研究。与接受标准胸部放射计划治疗的患者相比，数据定性地表明，功能性回避导致 DLCO 和 FEV1 下降幅度较小。所提供的数据可以帮助阐明功能性避免放射治疗对肺功能的潜在改善。
Four-dimensional computed tomography (4DCT)–ventilation-based functional avoidance uses 4DCT images to generate plans that avoid functional regions of the lung with the goal of reducing pulmonary toxic effects. A phase 2, multicenter, prospective study was completed to evaluate 4DCT-ventilation functional avoidance radiation therapy. The purpose of this study was to report the results for pretreatment to posttreatment pulmonary function test (PFT) changes for patients treated with functional avoidance radiation therapy. Patients with locally advanced lung cancer receiving chemoradiation were accrued. Functional avoidance plans based on 4DCT-ventilation images were generated. PFTs were obtained at baseline and 3 months after chemoradiation. Differences for PFT metrics are reported, including diffusing capacity for carbon monoxide (DLCO), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). PFT metrics were compared for patients who did and did not experience grade 2 or higher pneumonitis. Fifty-six patients enrolled on the study had baseline and posttreatment PFTs evaluable for analysis. The mean change in DLCO, FEV1, and FVC was –11.6% ± 14.2%, –5.6% ± 16.9%, and –9.0% ± 20.1%, respectively. The mean change in DLCO was –15.4% ± 14.4% for patients with grade 2 or higher radiation pneumonitis and –10.8% ± 14.1% for patients with grade <2 radiation pneumonitis (P = .37). The mean change in FEV1 was –14.3% ± 22.1% for patients with grade 2 or higher radiation pneumonitis and –3.9% ± 15.4% for patients with grade <2 radiation pneumonitis (P = .09). The current work is the first to quantitatively characterize PFT changes for patients with lung cancer treated on a prospective functional avoidance radiation therapy study. In comparison with patients treated with standard thoracic radiation planning, the data qualitatively show that functional avoidance resulted in less of a decline in DLCO and FEV1. The presented data can help elucidate the potential pulmonary function improvement with functional avoidance radiation therapy.