Lung Functional Avoidance Radiotherapy Using Hyperpolarized Xenon MRI

使用超极化氙 MRI 进行肺功能性回避放射治疗

• 批准号: 10490280
• 负责人: STEPHEN J KADLECEK
• 金额: $ 69.65万
• 依托单位: XEMED, LLC
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-17 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10490280
• 关键词: 3-Dimensional; Acute; Address; Affinity; Aftercare; Alveolar wall; Authorization documentation; Biological Markers; Blood; Blood Circulation; Breathing; Cancer Patient; Characteristics; Chronic; Climacteric; Communication; Consensus; Consequentialism; Control Groups; Custom; Development Plans; Dose; Dose-Rate; Enrollment; Erythrocytes; Esophagus; Exhibits; Fibrosis; Functional Imaging; Gases; Heart; Hemoglobin; Heterogeneity; Incidence; Industrialization; Infrastructure; Institutional Review Boards; Insurance Carriers; Intensity-Modulated Radiotherapy; Investments; Kinetics; Location; Lung; Magnetic Resonance Imaging; Malignant Neoplasms; Malignant neoplasm of lung; Maps; Measures; Methods; Organ; Outcome; Patients; Performance; Perfusion; Phase; Phase II Clinical Trials; Phase III Clinical Trials; Positron-Emission Tomography; Procedures; Protocols documentation; Public Health; Pulmonary Emphysema; Pulmonary Fibrosis; Pulmonary Inflammation; Pulmonary function tests; Quality of life; Radiation; Radiation Dosage; Radiation Dose Unit; Radiation Fibrosis; Radiation Pneumonitis; Radiation therapy; Randomized; Research Personnel; Resolution; Risk; Series; Services; Severities; Signal Transduction; Site; Solubility; Spirometry; Structure; Structure of parenchyma of lung; Techniques; Technology; Tissues; Tracer; Translating; Treatment Protocols; United States National Institutes of Health; Vertebral column; Xenon; base; cancer radiation therapy; chemotherapy; cohort; comorbidity; cost; dosage; follow-up; four-dimensional computed tomography; functional decline; high resolution imaging; imaging modality; improved; improved outcome; individualized medicine; industry partner; loss of function; meetings; novel; open label; patient stratification; preservation; primary endpoint; pulmonary function; recruit; research and development; secondary endpoint; single photon emission computed tomography; standard of care; translational study; treatment planning; tumor; ventilation

SUMMARY Customized 3D planning of radiation therapy for lung cancer delivers a lethal dose to the tumor region while avoiding important structures (spine) and organs (esophagus, heart, lungs) Since radiation dose to functioning lung is associated with acute radiation pneumonitis and chronic radiation fibrosis, researchers seek to shift dosage preferentially away from lung regions with highest function. Several lung functional imaging modalities have been investigated (ventilation- perfusion SPECT and PET, 4DCT, hyperpolarized 3He). These studies indicate that regional ventilation is not the optimal biomarker. What is needed is a high-resolution imaging modality, tolerable to patients who have difficulty holding their breath, that delineates regions of full lung function warranting preservation, and also identifies regions whose function is irrevocably gone. Hyperpolarized xenon-129 (HXe) MRI provides highly detailed maps of several lung functional characteristics. Its solubility in tissues and affinity for hemoglobin allow it to be used as a tracer for gas exchange kinetics, a so-called “regional DLCO”. Up until now, HXe imaging modalities required long breath holds, which are not well tolerated by lung-compromised patients. We developed an HXe assessment technique that probes several lung function characteristics, including gas exchange to/from red blood cells, with a natural tidal-breathing protocol. Our industrial team developed an automated xenon hyperpolarizer that delivers the required multi-liter volumes at polarizations that approach 50%, enabling this protocol to become routine. We propose a translational study applying HXe MRI to functional avoidance plan optimization to minimize fibrosis in lung cancer patients. To maximize statistical significance, we stratify the patient cohort selecting patients with significant heterogeneity: half with de novo lung cancer with GOLD stage 3+ emphysema comorbidity and half receiving RT for their second (primary) lung cancer. Maps will delineate three functional regions: full function with both ventilation and gas exchange to RBCs (extra importance for avoidance), regions where function is irrevocably absent (reduced avoidance), and other regions where function may be present or recoverable (normal avoidance). In year 1 we conduct an open-label trial to optimize the functional imaging protocols with upgraded hardware. With IRB and DSMB approval, our Phase 2 clinical trial will enroll 70 patients: half receiving standard-of-care treatment and half undergoing RT guided by HXe MRI. Six-month post-treatment assessments include changes in HXe MRI, for regional correlation with local dose. Primary endpoint will be change in DLCO, with secondary endpoints of breathing- related quality of life change from baseline, spirometry/DLCO relative to predicted, incidence/severity of pneumonitis, and change in HXe-MRI.

SUMMARY Customized 3D planning of radiation therapy for lung cancer delivers a lethal dose to the tumor region while avoiding important structures (spine) and organs (esophagus, heart, lungs) Since radiation dose to functioning lung is associated with acute radiation pneumonitis and chronic radiation fibrosis, researchers seek to shift dosage preferentially away from lung regions with highest function. Several lung functional imaging modalities have been investigated (ventilation- perfusion SPECT and PET, 4DCT, hyperpolarized 3He). These studies indicate that regional ventilation is not the optimal biomarker. What is needed is a high-resolution imaging modality, tolerable to patients who have difficulty holding their breath, that delineates regions of full lung function warranting preservation, and also identifies regions whose function is irrevocably gone. Hyperpolarized xenon-129 (HXe) MRI provides highly detailed maps of several lung functional characteristics. Its solubility in tissues and affinity for hemoglobin allow it to be used as a tracer for gas exchange kinetics, a so-called “regional DLCO”. Up until now, HXe imaging modalities required long breath holds, which are not well tolerated by lung-compromised patients. We developed an HXe assessment technique that probes several lung function characteristics, including gas exchange to/from red blood cells, with a natural tidal-breathing protocol. Our industrial team developed an automated xenon hyperpolarizer that delivers the required multi-liter volumes at polarizations that approach 50%, enabling this protocol to become routine. We propose a translational study applying HXe MRI to functional avoidance plan optimization to minimize fibrosis in lung cancer patients. To maximize statistical significance, we stratify the patient cohort selecting patients with significant heterogeneity: half with de novo lung cancer with GOLD stage 3+ emphysema comorbidity and half receiving RT for their second (primary) lung cancer. Maps will delineate three functional regions: full function with both ventilation and gas exchange to RBCs (extra importance for avoidance), regions where function is irrevocably absent (reduced avoidance), and other regions where function may be present or recoverable (normal avoidance). In year 1 we conduct an open-label trial to optimize the functional imaging protocols with upgraded hardware. With IRB and DSMB approval, our Phase 2 clinical trial will enroll 70 patients: half receiving standard-of-care treatment and half undergoing RT guided by HXe MRI. Six-month post-treatment assessments include changes in HXe MRI, for regional correlation with local dose. Primary endpoint will be change in DLCO, with secondary endpoints of breathing- related quality of life change from baseline, spirometry/DLCO relative to predicted, incidence/severity of pneumonitis, and change in HXe-MRI.