Priority-driven plan optimization in locally advanced lung patients based on perfusion SPECT imaging

Martha M. Matuszak, Charles Matrosic, David Jarema, Daniel L. McShan, Matthew H. Stenmark, Dawn Owen, Shruti Jolly, Feng Ming Kong, Randall K. Ten Haken

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose Limits on mean lung dose (MLD) allow for individualization of radiation doses at safe levels for patients with lung tumors. However, MLD does not account for individual differences in the extent or spatial distribution of pulmonary dysfunction among patients, which leads to toxicity variability at the same MLD. We investigated dose rearrangement to minimize the radiation dose to the functional lung as assessed by perfusion single photon emission computed tomography (SPECT) and maximize the target coverage to maintain conventional normal tissue limits. Methods and materials Retrospective plans were optimized for 15 patients with locally advanced non-small cell lung cancer who were enrolled in a prospective imaging trial. A staged, priority-based optimization system was used. The baseline priorities were to meet physical MLD and other dose constraints for organs at risk, and to maximize the target generalized equivalent uniform dose (gEUD). To determine the benefit of dose rearrangement with perfusion SPECT, plans were reoptimized to minimize the generalized equivalent uniform functional dose (gEUfD) to the lung as the subsequent priority. Results When only physical MLD is minimized, lung gEUfD was 12.6 ± 4.9 Gy (6.3-21.7 Gy). When the dose is rearranged to minimize gEUfD directly in the optimization objective function, 10 of 15 cases showed a decrease in lung gEUfD of >20% (lung gEUfD mean 9.9 ± 4.3 Gy, range 2.1-16.2 Gy) while maintaining equivalent planning target volume coverage. Although all dose-limiting constraints remained unviolated, the dose rearrangement resulted in slight gEUD increases to the cord (5.4 ± 3.9 Gy), esophagus (3.0 ± 3.7 Gy), and heart (2.3 ± 2.6 Gy). Conclusions Priority-driven optimization in conjunction with perfusion SPECT permits image guided spatial dose redistribution within the lung and allows for a reduced dose to the functional lung without compromising target coverage or exceeding conventional limits for organs at risk.

Original languageEnglish (US)
Pages (from-to)281-289
Number of pages9
JournalAdvances in Radiation Oncology
Volume1
Issue number4
DOIs
StatePublished - Oct 1 2016

Fingerprint

Single-Photon Emission-Computed Tomography
Perfusion
Lung
Organs at Risk
Radiation
Individuality
Non-Small Cell Lung Carcinoma
Esophagus

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Matuszak, M. M., Matrosic, C., Jarema, D., McShan, D. L., Stenmark, M. H., Owen, D., ... Ten Haken, R. K. (2016). Priority-driven plan optimization in locally advanced lung patients based on perfusion SPECT imaging. Advances in Radiation Oncology, 1(4), 281-289. https://doi.org/10.1016/j.adro.2016.10.007

Priority-driven plan optimization in locally advanced lung patients based on perfusion SPECT imaging. / Matuszak, Martha M.; Matrosic, Charles; Jarema, David; McShan, Daniel L.; Stenmark, Matthew H.; Owen, Dawn; Jolly, Shruti; Kong, Feng Ming; Ten Haken, Randall K.

In: Advances in Radiation Oncology, Vol. 1, No. 4, 01.10.2016, p. 281-289.

Research output: Contribution to journalArticle

Matuszak, MM, Matrosic, C, Jarema, D, McShan, DL, Stenmark, MH, Owen, D, Jolly, S, Kong, FM & Ten Haken, RK 2016, 'Priority-driven plan optimization in locally advanced lung patients based on perfusion SPECT imaging', Advances in Radiation Oncology, vol. 1, no. 4, pp. 281-289. https://doi.org/10.1016/j.adro.2016.10.007
Matuszak, Martha M. ; Matrosic, Charles ; Jarema, David ; McShan, Daniel L. ; Stenmark, Matthew H. ; Owen, Dawn ; Jolly, Shruti ; Kong, Feng Ming ; Ten Haken, Randall K. / Priority-driven plan optimization in locally advanced lung patients based on perfusion SPECT imaging. In: Advances in Radiation Oncology. 2016 ; Vol. 1, No. 4. pp. 281-289.
@article{a6aaab1457b84782b69589a749c0bada,
title = "Priority-driven plan optimization in locally advanced lung patients based on perfusion SPECT imaging",
abstract = "Purpose Limits on mean lung dose (MLD) allow for individualization of radiation doses at safe levels for patients with lung tumors. However, MLD does not account for individual differences in the extent or spatial distribution of pulmonary dysfunction among patients, which leads to toxicity variability at the same MLD. We investigated dose rearrangement to minimize the radiation dose to the functional lung as assessed by perfusion single photon emission computed tomography (SPECT) and maximize the target coverage to maintain conventional normal tissue limits. Methods and materials Retrospective plans were optimized for 15 patients with locally advanced non-small cell lung cancer who were enrolled in a prospective imaging trial. A staged, priority-based optimization system was used. The baseline priorities were to meet physical MLD and other dose constraints for organs at risk, and to maximize the target generalized equivalent uniform dose (gEUD). To determine the benefit of dose rearrangement with perfusion SPECT, plans were reoptimized to minimize the generalized equivalent uniform functional dose (gEUfD) to the lung as the subsequent priority. Results When only physical MLD is minimized, lung gEUfD was 12.6 ± 4.9 Gy (6.3-21.7 Gy). When the dose is rearranged to minimize gEUfD directly in the optimization objective function, 10 of 15 cases showed a decrease in lung gEUfD of >20{\%} (lung gEUfD mean 9.9 ± 4.3 Gy, range 2.1-16.2 Gy) while maintaining equivalent planning target volume coverage. Although all dose-limiting constraints remained unviolated, the dose rearrangement resulted in slight gEUD increases to the cord (5.4 ± 3.9 Gy), esophagus (3.0 ± 3.7 Gy), and heart (2.3 ± 2.6 Gy). Conclusions Priority-driven optimization in conjunction with perfusion SPECT permits image guided spatial dose redistribution within the lung and allows for a reduced dose to the functional lung without compromising target coverage or exceeding conventional limits for organs at risk.",
author = "Matuszak, {Martha M.} and Charles Matrosic and David Jarema and McShan, {Daniel L.} and Stenmark, {Matthew H.} and Dawn Owen and Shruti Jolly and Kong, {Feng Ming} and {Ten Haken}, {Randall K.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1016/j.adro.2016.10.007",
language = "English (US)",
volume = "1",
pages = "281--289",
journal = "Advances in Radiation Oncology",
issn = "2452-1094",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Priority-driven plan optimization in locally advanced lung patients based on perfusion SPECT imaging

AU - Matuszak, Martha M.

AU - Matrosic, Charles

AU - Jarema, David

AU - McShan, Daniel L.

AU - Stenmark, Matthew H.

AU - Owen, Dawn

AU - Jolly, Shruti

AU - Kong, Feng Ming

AU - Ten Haken, Randall K.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Purpose Limits on mean lung dose (MLD) allow for individualization of radiation doses at safe levels for patients with lung tumors. However, MLD does not account for individual differences in the extent or spatial distribution of pulmonary dysfunction among patients, which leads to toxicity variability at the same MLD. We investigated dose rearrangement to minimize the radiation dose to the functional lung as assessed by perfusion single photon emission computed tomography (SPECT) and maximize the target coverage to maintain conventional normal tissue limits. Methods and materials Retrospective plans were optimized for 15 patients with locally advanced non-small cell lung cancer who were enrolled in a prospective imaging trial. A staged, priority-based optimization system was used. The baseline priorities were to meet physical MLD and other dose constraints for organs at risk, and to maximize the target generalized equivalent uniform dose (gEUD). To determine the benefit of dose rearrangement with perfusion SPECT, plans were reoptimized to minimize the generalized equivalent uniform functional dose (gEUfD) to the lung as the subsequent priority. Results When only physical MLD is minimized, lung gEUfD was 12.6 ± 4.9 Gy (6.3-21.7 Gy). When the dose is rearranged to minimize gEUfD directly in the optimization objective function, 10 of 15 cases showed a decrease in lung gEUfD of >20% (lung gEUfD mean 9.9 ± 4.3 Gy, range 2.1-16.2 Gy) while maintaining equivalent planning target volume coverage. Although all dose-limiting constraints remained unviolated, the dose rearrangement resulted in slight gEUD increases to the cord (5.4 ± 3.9 Gy), esophagus (3.0 ± 3.7 Gy), and heart (2.3 ± 2.6 Gy). Conclusions Priority-driven optimization in conjunction with perfusion SPECT permits image guided spatial dose redistribution within the lung and allows for a reduced dose to the functional lung without compromising target coverage or exceeding conventional limits for organs at risk.

AB - Purpose Limits on mean lung dose (MLD) allow for individualization of radiation doses at safe levels for patients with lung tumors. However, MLD does not account for individual differences in the extent or spatial distribution of pulmonary dysfunction among patients, which leads to toxicity variability at the same MLD. We investigated dose rearrangement to minimize the radiation dose to the functional lung as assessed by perfusion single photon emission computed tomography (SPECT) and maximize the target coverage to maintain conventional normal tissue limits. Methods and materials Retrospective plans were optimized for 15 patients with locally advanced non-small cell lung cancer who were enrolled in a prospective imaging trial. A staged, priority-based optimization system was used. The baseline priorities were to meet physical MLD and other dose constraints for organs at risk, and to maximize the target generalized equivalent uniform dose (gEUD). To determine the benefit of dose rearrangement with perfusion SPECT, plans were reoptimized to minimize the generalized equivalent uniform functional dose (gEUfD) to the lung as the subsequent priority. Results When only physical MLD is minimized, lung gEUfD was 12.6 ± 4.9 Gy (6.3-21.7 Gy). When the dose is rearranged to minimize gEUfD directly in the optimization objective function, 10 of 15 cases showed a decrease in lung gEUfD of >20% (lung gEUfD mean 9.9 ± 4.3 Gy, range 2.1-16.2 Gy) while maintaining equivalent planning target volume coverage. Although all dose-limiting constraints remained unviolated, the dose rearrangement resulted in slight gEUD increases to the cord (5.4 ± 3.9 Gy), esophagus (3.0 ± 3.7 Gy), and heart (2.3 ± 2.6 Gy). Conclusions Priority-driven optimization in conjunction with perfusion SPECT permits image guided spatial dose redistribution within the lung and allows for a reduced dose to the functional lung without compromising target coverage or exceeding conventional limits for organs at risk.

UR - http://www.scopus.com/inward/record.url?scp=85007359778&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85007359778&partnerID=8YFLogxK

U2 - 10.1016/j.adro.2016.10.007

DO - 10.1016/j.adro.2016.10.007

M3 - Article

AN - SCOPUS:85007359778

VL - 1

SP - 281

EP - 289

JO - Advances in Radiation Oncology

JF - Advances in Radiation Oncology

SN - 2452-1094

IS - 4

ER -