Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Spect-guidance to Reduce Radioactive Dose to Functioning Lung for Stage III Non-small Cell Lung Cancer

  • Wang, Zhong-Tang (Sixth Department of Radiation Oncology, Shandong Cancer Hospital) ;
  • Wei, Li-Li (The Department of Clinical Laboratory, Shandong Cancer Hospital) ;
  • Ding, Xiu-Ping (Sixth Department of Radiation Oncology, Shandong Cancer Hospital) ;
  • Sun, Ming-Ping (Sixth Department of Radiation Oncology, Shandong Cancer Hospital) ;
  • Sun, Hong-Fu (Sixth Department of Radiation Oncology, Shandong Cancer Hospital) ;
  • Li, Bao-Sheng (Sixth Department of Radiation Oncology, Shandong Cancer Hospital)
  • Published : 2013.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To investigate the treatment effect of additional information obtained by single photon emission computed tomography (SPECT) lung perfusion imaging (LPI) in the radiotherapy planning process for patients with stage III non-small cell lung cancer (NSCLC). Methods: 39 patients with stage III NSCLC were enrolled. Gross tumor volume (GTV) was outlined by SPECT/CT images, SPECT-LPIs being used to define functional lung (FL) and non-functional lung (NFL) regions. Two sets of IMRT plans were designed to deliver 64Gy to PTV. One was a regular IMRT plan using CT images only (Plan 1), and the other was a corresponding IMRT plan using co-registered images (Plan 2). $FL_{Vx}$ (the % volume of functional lung receiving ${\geq}$x Gy) and $WL_{Vx}$ (% volume of whole lung to receive ${\geq}$x Gy) were compared by paired Student's t test. Kendalls correlation was used to analyze the factor (s) related with the FLV20 decrease. Results: Compared with plan 1, both $WL_{Vx}$ and $FL_{Vx}$ were decreased in plan 2. $WL_{V10}$, $WL_{V15}$, $WL_{V20}$, $WL_{V25}$, $WL_{V30}$ and $WL_{V35}$ decreased 9.7%, 13.8%, 17.2%, 12.9%, 9.8% and 9.8%, and $FL_{V10}$, $FL_{V15}$, $FL_{V20}$, $FL_{V25}$, $FL_{V30}$ and $FL_{V35}$ decreased 10.8%, 14.6%, 17.3%, 14.5%, 14.5% and 10.5%. $FL_{Vx}$ decreased significantly compared with $WL_{Vx}$. There were significant differences in $WL_{V10}$, $WL_{V15}$, $WL_{V20}$, $WL_{V25}$, $WL_{V3}$ and $FL_{V10}$, $FL_{V15}$, $FL_{V20}$, $FL_{V25}$, $FL_{V30}$ between plan 1 and plan 2 (P=0.002, 0.000, 0.000, 0.005, 0.027 and 0.002, 0.000, 0.000, 0.006, 0.010). According to Kendall correlation analysis, NFL had a negative relation with the percentage FLV20 decrease (r=-0.559, P<0.01), while the distance of PTV and NFL center had a significantly positive relation with the percentage of FLV20 decrease (r=0.768, P<0.01). Conclusion: Routine use of SPECT-LPI for patients undergoing radiotherapy planning for stage III NSCLC appears warranted.

Keywords

References

  1. Abratt RP, Willcox PA (1995). The effect of irradiation on lung function and perfusion in patients with lung cancer. Int J Radiat Oncol Biol Phys, 31, 915-9. https://doi.org/10.1016/0360-3016(94)00513-3
  2. Boersma LJ, Damen EM, de Boer RW, et al (1995). Estimation of overall pulmonary function after irradiation using dose-effect relations for local functional injury. Radiother Oncol, 36, 15-23. https://doi.org/10.1016/0167-8140(95)01580-A
  3. Byhardt RW, Scott CB, Sause WT, et al (1998). Response, toxicity, failure patterns and survival in five Radiation Therapy Oncology Group (RTOG) trials of sequential and/or concurrent chemotherapy and radiotherapy for locally advanced non-small-cell carcinoma of the lung. Int J Radiat Oncol Biol Phys, 42, 469-78. https://doi.org/10.1016/S0360-3016(98)00251-X
  4. De Jaeger K, Seppenwoolde Y, Boersma LJ, et al (2003). Pulmonary function following high-dose radiotherapy of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 55, 1331-40. https://doi.org/10.1016/S0360-3016(02)04389-4
  5. Garipagaoglu M, Munley MT, Hollis D, et al (1999). The effect of patient-specific factors on radiation-induced regional lung injury. Int J Radiat Oncol Biol Phys, 45, 331-8.
  6. Graham MV, Purdy JA, Emami B, et al (1999). Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J RadiatOncol Biol Phys, 45, 323-9.
  7. Grills IS, Yan D, Martinez AA, et al (2003). Potential for reduced toxicity and dose escalation in the treatment of inoperable non-small-cell lung cancer: a comparison of intensity-modulated radiation therapy (IMRT), 3D conformal radiation, and elective nodal irradiation. Int J Radiat Oncol Biol Phys, 57, 875-90. https://doi.org/10.1016/S0360-3016(03)00743-0
  8. Hong R, Halama J, Bova D, Sethi A, Emami B (2007). Correlation of PET standard uptake value and CT window-level thresholds for target delineation in CT-based radiation treatment planning. Int J Radiat Oncol Biol Phys, 67, 720-6. https://doi.org/10.1016/j.ijrobp.2006.09.039
  9. Kubota R, Yamada S, Kubota K, et al (1992). Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med, 33, 1972-80.
  10. Kwa SL, Lebesque JV, Theuws JC, et al (1998). Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys, 42, 1-9.
  11. Lavrenkov K, Christian JA, Partridge M, et al (2007). A potential to reduce pulmonary toxicity: the use of perfusion SPECT with IMRT for functional lung avoidance in radiotherapy of non-small cell lung cancer. Radiother Oncol, 83, 156-62. https://doi.org/10.1016/j.radonc.2007.04.005
  12. Liu HH, Wang X, Dong L, et al (2004). Feasibility of sparing lung and other thoracic structures with intensity-modulated radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys,58, 1268-79. https://doi.org/10.1016/j.ijrobp.2003.09.085
  13. Marks LB, Munley MT, Spencer DP, et al (1997). Quantification of radiation-induced regional lung injury with perfusion imaging. Int J Radiat Oncol Biol Phys, 38, 399-409. https://doi.org/10.1016/S0360-3016(97)00013-8
  14. Mornex F (2004). Non-small cell lung cancer: some important questions to be solved. Semin Radiat Oncol, 14, 277-9. https://doi.org/10.1016/j.semradonc.2004.07.001
  15. Murshed H, Liu HH, Liao Z, et al (2004). Dose and volume reduction for normal lung using intensity-modulated radiotherapy for advanced staged non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 58, 1258-67. https://doi.org/10.1016/j.ijrobp.2003.09.086
  16. Osborne D, Jaszczak R, Coleman RE, Greer K, Lischko M (1982). In vivo regional quantitation of intrathoracic Tc-99m using SPECT: concise communication. J Nucl Med, 23, 446-50.
  17. Osborne D, Jaszczak RJ, Greer K, Lischko M, Coleman RE (1985). SPECT quantification of technetium-99m microspheres within the canine lung. J Comput Assist Tomogr, 9, 73-7.
  18. Parkin DM, Bray F, Ferlay J, Pisani P (2005). Global cancer statistics, 2002. CA Cancer J Clin, 55, 74-108. https://doi.org/10.3322/canjclin.55.2.74
  19. Partridge M, Ramos M, Sardaro A, Brada M (2011). Dose escalation for non-small cell lung cancer: analysis and modelling of published literature. Radiother Oncol, 99, 6-11. https://doi.org/10.1016/j.radonc.2011.02.014
  20. Sause W, Kolesar P, Taylor S, et al (2000). Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. Chest, 117, 358-64. https://doi.org/10.1378/chest.117.2.358
  21. Seppenwoolde Y, Lebesque LW, de Jaeger K, et al (2003). Comparing different NTCP models that predict the incidence of radiation pneumonitis. Normal tissue complication probability. Int J Radiat Oncol Biol Phys, 55, 724-35. https://doi.org/10.1016/S0360-3016(02)03986-X
  22. Seppenwoolde Y, Muller SH, Theuws JC, et al (2000). Radiation dose-effect relations and local recovery in perfusion for patients with non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 47, 681-90. https://doi.org/10.1016/S0360-3016(00)00454-5
  23. Sobin LH, Fleming ID (1997). TNM Classification of Malignant Tumors, fifth edition (1997). Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer, 80, 1803-4. https://doi.org/10.1002/(SICI)1097-0142(19971101)80:9<1803::AID-CNCR16>3.0.CO;2-9
  24. Socinski MA, Zhang C, Herndon JE 2nd, et al (2004). Combined modality trials of the Cancer and Leukemia Group B in stage III non small cell lung cancer: analysis of factors influencing survival and toxicity. Ann Oncol, 15, 1033-41. https://doi.org/10.1093/annonc/mdh282
  25. West JB (1992). Pulmonary pathophysiology. 4th ed. Baltimore, MD: Williams &Wilkins.
  26. Woel RT, Munley MT, Hollis D, et al (2002). The time course of radiation therapy-induced reductions in regional perfusion: a prospective study with >5 years of follow-up. Int J Radiat Oncol Biol Phys, 52, 58-67. https://doi.org/10.1016/S0360-3016(01)01809-0
  27. Yuan ST, Frey KA, Gross MD, et al (2011). Semiquantification and classification of local pulmonary function by V/Q single photon emission computed tomography in patients with non-small cell lung cancer: potential indication for radiotherapy planning. J Thorac Oncol, 6, 71-8. https://doi.org/10.1097/JTO.0b013e3181f77b40
  28. Zasadny KR, Kison PV, Quint LE, Wahl RL (1996). Untreated lung cancer: quantification of systematic distortion of tumor size and shape on non-attenuation-corrected 2-[fluorine-18] fluoro-2-deoxy-D-glucose PET scans. Radiology, 201, 873-6. https://doi.org/10.1148/radiology.201.3.8939245