PMID- 36427643
OWN - NLM
STAT- MEDLINE
DCOM- 20230322
LR  - 20230511
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 115
IP  - 5
DP  - 2023 Apr 1
TI  - Four-Dimensional Computed Tomography Ventilation Image-Guided Lung Functional 
      Avoidance Radiation Therapy: A Single-Arm Prospective Pilot Clinical Trial.
PG  - 1144-1154
LID - S0360-3016(22)03550-7 [pii]
LID - 10.1016/j.ijrobp.2022.11.026 [doi]
AB  - PURPOSE: The primary objective of this prospective pilot trial was to assess the 
      safety and feasibility of lung functional avoidance radiation therapy (RT) with 
      4-dimensional (4D) computed tomography (CT) ventilation imaging. METHODS AND 
      MATERIALS: Patients with primary lung cancer or metastatic disease to the lungs 
      to receive conventionally fractionated RT (CFRT) or stereotactic body RT (SBRT) 
      were eligible. Standard-of-care 4D-CT scans were used to generate ventilation 
      images through image processing/analysis. Each patient required a standard 
      intensity modulated RT plan and ventilation image guided functional avoidance 
      plan. The primary endpoint was the safety of functional avoidance RT, defined as 
      the rate of grade >/=3 adverse events (AEs) that occurred </=12 months after 
      treatment. Protocol treatment was considered safe if the rates of grade >/=3 
      pneumonitis and esophagitis were <13% and <21%, respectively for CFRT, and if the 
      rate of any grade >/=3 AEs was <28% for SBRT. Feasibility of functional avoidance 
      RT was assessed by comparison of dose metrics between the 2 plans using the 
      Wilcoxon signed-rank test. RESULTS: Between May 2015 and November 2019, 34 
      patients with non-small cell lung cancer were enrolled, and 33 patients were 
      evaluable (n = 24 for CFRT; n = 9 for SBRT). Median follow-up was 14.7 months. 
      For CFRT, the rates of grade >/=3 pneumonitis and esophagitis were 4.2% (95% 
      confidence interval, 0.1%-21.1%) and 12.5% (2.7%-32.4%). For SBRT, no patients 
      developed grade >/=3 AEs. Compared with the standard plans, the functional 
      avoidance plans significantly (P < .01) reduced the lung dose-function metrics 
      without compromising target coverage or adherence to standard organs at risk 
      constraints. CONCLUSIONS: This study, representing one of the first prospective 
      investigations on lung functional avoidance RT, demonstrated that the 4D-CT 
      ventilation image guided functional avoidance RT that significantly reduced dose 
      to ventilated lung regions could be safely administered, adding to the growing 
      body of evidence for its clinical utility.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Yamamoto, Tokihiro
AU  - Yamamoto T
AD  - Department of Radiation Oncology, University of California Davis School of 
      Medicine, Sacramento, California. Electronic address: toyamamoto@ucdavis.edu.
FAU - Kabus, Sven
AU  - Kabus S
AD  - Department of Medical Image Processing & Analytics, Philips Research, Hamburg, 
      Germany.
FAU - Bal, Matthieu
AU  - Bal M
AD  - Philips Healthcare, Best, The Netherlands.
FAU - Keall, Paul J
AU  - Keall PJ
AD  - ACRF Image X Institute, University of Sydney, Sydney, New South Wales, Australia.
FAU - Moran, Angel
AU  - Moran A
AD  - Department of Radiation Oncology, University of California Davis School of 
      Medicine, Sacramento, California.
FAU - Wright, Cari
AU  - Wright C
AD  - Department of Radiation Oncology, University of California Davis School of 
      Medicine, Sacramento, California.
FAU - Benedict, Stanley H
AU  - Benedict SH
AD  - Department of Radiation Oncology, University of California Davis School of 
      Medicine, Sacramento, California.
FAU - Holland, Devin
AU  - Holland D
AD  - Office of Clinical Research, University of California Davis Comprehensive Cancer 
      Center, Sacramento, California.
FAU - Mahaffey, Nichole
AU  - Mahaffey N
AD  - Office of Clinical Research, University of California Davis Comprehensive Cancer 
      Center, Sacramento, California.
FAU - Qi, Lihong
AU  - Qi L
AD  - Department of Public Health Sciences, University of California, Davis, 
      California.
FAU - Daly, Megan E
AU  - Daly ME
AD  - Department of Radiation Oncology, University of California Davis School of 
      Medicine, Sacramento, California.
LA  - eng
GR  - K12 CA138464/CA/NCI NIH HHS/United States
GR  - P30 CA093373/CA/NCI NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20221124
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Humans
MH  - *Carcinoma, Non-Small-Cell Lung/diagnostic imaging/radiotherapy/pathology
MH  - Four-Dimensional Computed Tomography/methods
MH  - Lung/pathology
MH  - *Lung Neoplasms/diagnostic imaging/radiotherapy/pathology
MH  - Prospective Studies
MH  - Radiotherapy Planning, Computer-Assisted/methods
EDAT- 2022/11/26 06:00
MHDA- 2023/03/21 06:00
CRDT- 2022/11/25 19:25
PHST- 2022/07/19 00:00 [received]
PHST- 2022/10/28 00:00 [revised]
PHST- 2022/11/09 00:00 [accepted]
PHST- 2022/11/26 06:00 [pubmed]
PHST- 2023/03/21 06:00 [medline]
PHST- 2022/11/25 19:25 [entrez]
AID - S0360-3016(22)03550-7 [pii]
AID - 10.1016/j.ijrobp.2022.11.026 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2023 Apr 1;115(5):1144-1154. doi: 
      10.1016/j.ijrobp.2022.11.026. Epub 2022 Nov 24.