Regional Lung Function Profiles of Stage I and III Lung Cancer Patients: An Evaluation for Functional Avoidance Radiation Therapy.
Regional Lung Function Profiles of Stage I and III Lung Cancer Patients: An Evaluation for Functional Avoidance Radiation Therapy.
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DOI：
10.1016/j.ijrobp.2016.02.058
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发表时间：
2016-07-15
期刊：
影响因子：
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通讯作者：
Miften M
中科院分区：
文献类型：
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作者：
Vinogradskiy Y;Schubert L;Diot Q;Waxweiller T;Koo P;Castillo R;Castillo E;Guerrero T;Rusthoven C;Gaspar L;Kavanagh B;Miften M
4DCT-通气是一种令人兴奋的成像模式，它使用4DCT数据来计算肺功能图。临床试验的发展正在进行中，以使用4DCT通气成像优先保留接受放射治疗的患者的功能性肺。这项工作的目的是通过回顾性地描述不同阶段肺癌患者的剂量测定和功能概况来生成数据，以帮助临床试验设计。来自2个机构的共118名肺癌患者（36% I期和64% III期）用于本研究。使用患者的4DCT成像、可变形图像配准和基于密度变化的算法计算4DCT-通气图。为了评估每例患者的空间通气曲线，开发了定量和定性指标，包括基于呼吸机的缺陷观察和基于每个肺三分之一通气的指标。对于每例患者，我们使用临床剂量计算加权平均肺剂量（fMLD）和评估剂量空间位置与高功能肺之间相互作用的指标。定性和定量指标均显示2个阶段组之间的功能概况存在显著差异（p<0.01）。我们确定65%的III期患者和28%的I期患者存在通气缺陷。III期和I期患者的平均fMLD分别为19.6戈伊和5.4戈伊，两组均包含剂量和高功能区域之间存在较大空间重叠的患者。我们对118例患者进行的回顾性研究发现，65%的III期患者具有适合功能性回避的区域性通气特征。我们的研究结果表明，无论疾病阶段如何，剂量和高功能肺之间都可能存在独特的空间相互作用，这突出了评估每位患者的功能和开发个性化功能性回避治疗方法的重要性。
4DCT-ventilation is an exciting imaging modality that uses 4DCT data to calculate lung function maps. The development of clinical trials is underway to use 4DCT-ventilation imaging to preferentially spare functional lung in patients undergoing radiotherapy. The purpose of this work was to generate data to aide with clinical trial design by retrospectively characterizing dosimetric and functional profiles for patients with different stages of lung cancer disease A total of 118 lung cancer patients (36% stage I and 64% stage III) from 2 institutions were used for the study. A 4DCT-ventilation map was calculated using the patient’s 4DCT imaging, deformable image registration, and a density-change based algorithm. In order to assess each patient’s spatial ventilation profile both quantitative and qualitative metrics were developed including an observer-based defect observation and metrics based on the ventilation in each lung third. For each patient we used the clinical doses to calculate weighted mean lung doses (fMLD) and metrics that assessed the interplay between the spatial location of the dose and high-functioning lung. Both qualitative and quantitative metrics revealed a significant difference in functional profiles between the 2 stage groups (p<0.01). We determined that 65% of stage III and 28% of stage I patients had ventilation defects. Average fMLD was 19.6 Gy and 5.4 Gy for stage III and I patients respectively with both groups containing patients with large spatial overlap between dose and high-function regions. Our 118 patient retrospective study found that 65% stage III patients have regionally variant ventilation profiles that are suitable for functional avoidance. Our results suggest that regardless of disease stage, it is possible to have unique spatial interplay between dose and high-functional lung highlighting the importance of evaluating the function of each patient and developing a personalized functional avoidance treatment approach.