Changes in functional lung regions during the course of radiation therapy and their potential impact on lung dosimetry for non-small cell lung cancer

Xue Meng, Kirk Frey, Martha Matuszak, Stanton Paul, Randall Ten Haken, Jinming Yu, Feng Ming Kong

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose To study changes in functional activity on ventilation (V)/perfusion (Q) single-photon emission computed tomography (SPECT) during radiation therapy (RT) and explore the impact of such changes on lung dosimetry in patients with non-small cell lung cancer (NSCLC). Methods and Materials Fifteen NSCLC patients with centrally located tumors were enrolled. All patients were treated with definitive RT dose of ≥60 Gy. V/Q SPECT-CT scans were performed prior to and after delivery of 45 Gy of fractionated RT. SPECT images were used to define temporarily dysfunctional regions of lung caused by tumor or other potentially reversible conditions as B3. The functional lung (FL) was defined on SPECT by 2 separate approaches: FL1, a threshold of 30% of the maximum uptake of the patient's lung; and FL2, FL1 plus B3 region. The impact of changes in FL between initiation of RT and delivery of 45 Gy on lung dosimetry were analyzed. Results Fourteen patients (93%) had larger FL2 volumes than FL1 pre-RT (P<.001). Dysfunctional lung became functional in 11 patients (73%) on V SPECT and in 10 patients (67%) on Q SPECT. The dosimetric parameters generated from CT-based anatomical lung had significantly lower values in FL1 than FL2, with a median reduction in the volume of lung receiving a dose of at least 20 Gy (V20) of 3%, 5.6%, and mean lung dose of 0.95 and 1.55 on V and Q SPECT respectively. Conclusions Regional ventilation and perfusion function improve significantly during RT in centrally located NSCLC. Lung dosimetry values vary notably between different definitions of functional lung.

Original languageEnglish (US)
Pages (from-to)145-151
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume89
Issue number1
DOIs
StatePublished - May 1 2014

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Non-Small Cell Lung Carcinoma
lungs
dosimeters
radiation therapy
Radiotherapy
cancer
Single-Photon Emission-Computed Tomography
Lung
tomography
photons
Ventilation
ventilation
Perfusion
dosage
Radiation Dosage
delivery
Pneumonectomy
tumors
Neoplasms

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Changes in functional lung regions during the course of radiation therapy and their potential impact on lung dosimetry for non-small cell lung cancer. / Meng, Xue; Frey, Kirk; Matuszak, Martha; Paul, Stanton; Ten Haken, Randall; Yu, Jinming; Kong, Feng Ming.

In: International Journal of Radiation Oncology Biology Physics, Vol. 89, No. 1, 01.05.2014, p. 145-151.

Research output: Contribution to journalArticle

Meng, Xue ; Frey, Kirk ; Matuszak, Martha ; Paul, Stanton ; Ten Haken, Randall ; Yu, Jinming ; Kong, Feng Ming. / Changes in functional lung regions during the course of radiation therapy and their potential impact on lung dosimetry for non-small cell lung cancer. In: International Journal of Radiation Oncology Biology Physics. 2014 ; Vol. 89, No. 1. pp. 145-151.
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abstract = "Purpose To study changes in functional activity on ventilation (V)/perfusion (Q) single-photon emission computed tomography (SPECT) during radiation therapy (RT) and explore the impact of such changes on lung dosimetry in patients with non-small cell lung cancer (NSCLC). Methods and Materials Fifteen NSCLC patients with centrally located tumors were enrolled. All patients were treated with definitive RT dose of ≥60 Gy. V/Q SPECT-CT scans were performed prior to and after delivery of 45 Gy of fractionated RT. SPECT images were used to define temporarily dysfunctional regions of lung caused by tumor or other potentially reversible conditions as B3. The functional lung (FL) was defined on SPECT by 2 separate approaches: FL1, a threshold of 30{\%} of the maximum uptake of the patient's lung; and FL2, FL1 plus B3 region. The impact of changes in FL between initiation of RT and delivery of 45 Gy on lung dosimetry were analyzed. Results Fourteen patients (93{\%}) had larger FL2 volumes than FL1 pre-RT (P<.001). Dysfunctional lung became functional in 11 patients (73{\%}) on V SPECT and in 10 patients (67{\%}) on Q SPECT. The dosimetric parameters generated from CT-based anatomical lung had significantly lower values in FL1 than FL2, with a median reduction in the volume of lung receiving a dose of at least 20 Gy (V20) of 3{\%}, 5.6{\%}, and mean lung dose of 0.95 and 1.55 on V and Q SPECT respectively. Conclusions Regional ventilation and perfusion function improve significantly during RT in centrally located NSCLC. Lung dosimetry values vary notably between different definitions of functional lung.",
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