Changes in global function and regional ventilation and perfusion on SPECT during the course of radiotherapy in patients with non-small-cell lung cancer

Shuanghu Yuan, Kirk A. Frey, Milton D. Gross, James A. Hayman, Doug Arenberg, Xu Wei Cai, Nithya Ramnath, Khaled Hassan, Jean Moran, Avraham Eisbruch, Randall K. Ten Haken, Feng Ming Kong

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Abstract

Purpose: This study aimed to (1) examine changes in dyspnea, global pulmonary function test (PFT) results, and functional activity on ventilation (V)/perfusion (Q) single-photon emission computerized tomography (SPECT) scans during the course of radiation (RT), and (2) factors associated with the changes in patients with non-small-cell lung cancer (NSCLC). Methods and Materials: Fifty-six stage I to III NSCLC patients treated with definitive RT with or without chemotherapy were enrolled prospectively. Dyspnea was graded according to Common Terminology Criteria for Adverse Events version 3.0 prior to and weekly during RT. V/Q SPECT-computed tomography (CT) and PFTs were performed prior to and during RT at approximately 45 Gy. Functions of V and Q activities were assessed using a semiquantitative scoring of SPECT images. Results: Breathing improved significantly at the third week (mean dyspnea grade, 0.8 vs. 0.6; paired t-test p = 0.011) and worsened during the later course of RT (p > 0.05). Global PFT results did not change significantly, while regional lung function on V/Q SPECT improved significantly after ∼45 Gy. The V defect score (DS) was 4.9 pre-RT versus 4.3 during RT (p = 0.01); Q DS was 4.3 pre-RT versus 4.0 during RT (p < 0.01). Improvements in V and Q functions were seen primarily in the ipsilateral lung (V DS, 1.9 pre-RT versus 1.4 during RT, p < 0.01; Q DS, 1.7 pre-RT versus 1.5 during RT, p < 0.01). Baseline primary tumor volume was significantly correlated with pre-RT V/Q DS (p < 0.01). Patients with central lung tumors had greater interval changes in V and Q than those with more peripheral tumors (p <0.05 for both V and Q DS). Conclusions: Regional ventilation and perfusion improved during RT at 45 Gy. This suggests that adaptive planning based on V/Q SPECT during RT may allow sparing of functionally recoverable lung tissue.

Original languageEnglish (US)
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number4
DOIs
StatePublished - Mar 15 2012

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ventilation
Single-Photon Emission-Computed Tomography
Non-Small Cell Lung Carcinoma
lungs
Ventilation
radiation therapy
Radiotherapy
Perfusion
tomography
cancer
Radiation
photons
radiation
dyspnea
defects
pulmonary functions
Dyspnea
Lung
tumors
Respiratory Function Tests

Keywords

  • Non-small-cell lung cancer
  • Perfusion
  • Radiotherapy
  • Single-photon emission computerized tomography
  • Ventilation

ASJC Scopus subject areas

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

Cite this

Changes in global function and regional ventilation and perfusion on SPECT during the course of radiotherapy in patients with non-small-cell lung cancer. / Yuan, Shuanghu; Frey, Kirk A.; Gross, Milton D.; Hayman, James A.; Arenberg, Doug; Cai, Xu Wei; Ramnath, Nithya; Hassan, Khaled; Moran, Jean; Eisbruch, Avraham; Ten Haken, Randall K.; Kong, Feng Ming.

In: International Journal of Radiation Oncology Biology Physics, Vol. 82, No. 4, 15.03.2012.

Research output: Contribution to journalArticle

Yuan, Shuanghu ; Frey, Kirk A. ; Gross, Milton D. ; Hayman, James A. ; Arenberg, Doug ; Cai, Xu Wei ; Ramnath, Nithya ; Hassan, Khaled ; Moran, Jean ; Eisbruch, Avraham ; Ten Haken, Randall K. ; Kong, Feng Ming. / Changes in global function and regional ventilation and perfusion on SPECT during the course of radiotherapy in patients with non-small-cell lung cancer. In: International Journal of Radiation Oncology Biology Physics. 2012 ; Vol. 82, No. 4.
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AU - Gross, Milton D.

AU - Hayman, James A.

AU - Arenberg, Doug

AU - Cai, Xu Wei

AU - Ramnath, Nithya

AU - Hassan, Khaled

AU - Moran, Jean

AU - Eisbruch, Avraham

AU - Ten Haken, Randall K.

AU - Kong, Feng Ming

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N2 - Purpose: This study aimed to (1) examine changes in dyspnea, global pulmonary function test (PFT) results, and functional activity on ventilation (V)/perfusion (Q) single-photon emission computerized tomography (SPECT) scans during the course of radiation (RT), and (2) factors associated with the changes in patients with non-small-cell lung cancer (NSCLC). Methods and Materials: Fifty-six stage I to III NSCLC patients treated with definitive RT with or without chemotherapy were enrolled prospectively. Dyspnea was graded according to Common Terminology Criteria for Adverse Events version 3.0 prior to and weekly during RT. V/Q SPECT-computed tomography (CT) and PFTs were performed prior to and during RT at approximately 45 Gy. Functions of V and Q activities were assessed using a semiquantitative scoring of SPECT images. Results: Breathing improved significantly at the third week (mean dyspnea grade, 0.8 vs. 0.6; paired t-test p = 0.011) and worsened during the later course of RT (p > 0.05). Global PFT results did not change significantly, while regional lung function on V/Q SPECT improved significantly after ∼45 Gy. The V defect score (DS) was 4.9 pre-RT versus 4.3 during RT (p = 0.01); Q DS was 4.3 pre-RT versus 4.0 during RT (p < 0.01). Improvements in V and Q functions were seen primarily in the ipsilateral lung (V DS, 1.9 pre-RT versus 1.4 during RT, p < 0.01; Q DS, 1.7 pre-RT versus 1.5 during RT, p < 0.01). Baseline primary tumor volume was significantly correlated with pre-RT V/Q DS (p < 0.01). Patients with central lung tumors had greater interval changes in V and Q than those with more peripheral tumors (p <0.05 for both V and Q DS). Conclusions: Regional ventilation and perfusion improved during RT at 45 Gy. This suggests that adaptive planning based on V/Q SPECT during RT may allow sparing of functionally recoverable lung tissue.

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KW - Non-small-cell lung cancer

KW - Perfusion

KW - Radiotherapy

KW - Single-photon emission computerized tomography

KW - Ventilation

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