Quantification of global lung inflammation using volumetric 18F-FDG PET/CT parameters in locally advanced non-small-cell lung cancer patients treated with concurrent chemoradiotherapy: a comparison of photon and proton radiation therapy
Quantification of global lung inflammation using volumetric 18F-FDG PET/CT parameters in locally advanced non-small-cell lung cancer patients treated with concurrent chemoradiotherapy: a comparison of photon and proton radiation therapy
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DOI：
10.1097/mnm.0000000000000997
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发表时间：
2019-06-01
影响因子：
1.5
通讯作者：
Alavi, Abass
中科院分区：
文献类型：
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作者：
Rice, Stephanie R.;Saboury, Babak;Alavi, Abass
放射性肺炎是胸部放射治疗（RT）中的一种主要剂量限制性并发症，在RT后的最初几个月出现临床症状。我们评估了使用新型半自动肺分割技术定量肺实质糖酵解（PG）作为非小细胞肺癌（NSCLC）整体肺部炎症和放射诱导肺毒性替代物的可行性。患者和方法我们评估了18名连续的局部晚期NSCLC患者，这些患者在2010年至2014年期间接受了用确定的（中位数：66.6戈伊; 1.8戈伊分数）光子或质子RT治疗的治疗前和治疗后F-18-FDG PET/CT。使用3D Slicer通过执行简单阈值化进行肺体积分割。肺PG通过将全肺中的F-18-FDG摄取相加来计算。结果在9例接受光子RT治疗的患者中，发现同侧（平均差异：1400 +/- 510; P=0.02）和对侧（平均差异：1200 +/- 450; P=0.03）肺PG显著增加。在接受质子治疗的9例患者中，在同侧（P=0.30）或对侧肺（P=0.98）中均未观察到肺PG增加。结论质子治疗后，我们观察到双侧肺部炎症明显增加，但没有观察到整体肺部炎症的显著变化。未来需要更大规模的研究来确定这种差异是否与质子治疗的NSCLC患者放射性肺炎风险降低相关。
Introduction Radiation pneumonitis is a major dose-limiting complication in thoracic radiation therapy (RT) and presents clinically in the first few months after RT. We evaluated the feasibility of quantifying pulmonary parenchymal glycolysis (PG) as a surrogate of global lung inflammation and radiation-induced pulmonary toxicity using a novel semiautomatic lung segmentation technique in non-small-cell lung cancer (NSCLC) patients and compared PG in patients treated with photon or proton RT. Patients and methods We evaluated 18 consecutive locally advanced NSCLC patients who underwent pretreatment and post-treatment F-18-FDG PET/CT treated with definitive (median: 66.6 Gy; 1.8 Gy fractions) photon or proton RT between 2010 and 2014. Lung volume segmentation was conducted using 3D Slicer by performing simple thresholding. Pulmonary PG was calculated by summing F-18-FDG uptake in the whole lung. Results In nine patients treated with photon RT, significant increases in PG in both ipsilateral (mean difference: 1400 +/- 510; P=0.02) and contralateral (mean difference: 1200 +/- 450; P=0.03) lungs were noted. In nine patients treated with proton therapy, no increase in pulmonary PG was observed in either the ipsilateral (P=0.30) or contralateral lung (P=0.98). Conclusion We observed a significant increase in global lung inflammation bilaterally as measured by quantification of PG. However, no significant change in global lung inflammation was noted after proton therapy. Future larger studies are needed to determine whether this difference correlates with lower risks of radiation pneumonitis in NSCLC patients treated with proton therapy.