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

Shuanghu Yuan, Kirk A. Frey, Milton D. Gross, James A. Hayman, Doug Arenberg, Jeffrey L. Curtis, Xu Wei Cai, Nithya Ramnath, Gregory P. Kalemkerian, Randall K. Ten Haken, Avraham Eisbruch, Feng Ming Kong

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

INTRODUCTION: Perfusion (Q) single photon emission computed tomography (SPECT) has been used to divert dose away from higher-functioning lung during radiation therapy (RT) planning. This study aimed to (1) study regional lung function through coregistered pulmonary ventilation/perfusion (V/Q)-SPECT-CT and (2) classify these defects for its potential value in radiation planning in patients with non-small cell lung cancer (NSCLC). METHODS: Patients with stages I to III NSCLC requiring radiation-based therapy were eligible for this prospective study. V/Q-SPECT performed within 2 weeks before the start of radiation was interpreted by nuclear medicine physicians and then measured by a semiquantitative score. The potential mechanism of V and Q defects was analyzed; the potential impact of V/Q-SPECT over Q-SPECT alone was completed through classified applications (high-dose RT versus RT avoidance) during planning. RESULTS: Images of 51 consecutive patients were analyzed. The V and Q defects were matched, reverse mismatched (V defect > Q defect), and mismatched (Q defect > V defect) in 61, 31, and 8% of patients, respectively. Tumor was the leading cause of the defects of ipsilateral lung in 73% of patients. The defect scores of the ipsilateral lung were greater in patients with central primaries than those with peripheral primaries for both V-SPECT (2.3 ± 1.1 versus 1.5 ± 0.8, p = 0.017) and Q-SPECT (2.2 ± 0.8 versus 1.4 ± 0.6, p = 0.000). The patients with chronic obstructive pulmonary disease had greater defect scores in contralateral lung for both V-SPECT (1.5 ± 0.7 versus 1.0 ± 0.8, p = 0.006) and Q-SPECT (1.4 ± 0.6 versus 1.0 ± 0.4, p = 0.010). On assessing the potential value of SPECT on RT plan, 39% of patients could have their RT plan when applying V/Q-SPECT rather than Q-SPECT alone. CONCLUSIONS: V/Q-SPECT provides a more comprehensive functional assessment, may provide additional value over Q-SPECT alone in assessing local pulmonary function, and guide RT plan decisions in patients with NSCLC.

Original languageEnglish (US)
Pages (from-to)71-78
Number of pages8
JournalJournal of Thoracic Oncology
Volume6
Issue number1
DOIs
StatePublished - Jan 2011

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

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    Yuan, S., Frey, K. A., Gross, M. D., Hayman, J. A., Arenberg, D., Curtis, J. L., Cai, X. W., Ramnath, N., Kalemkerian, G. P., Ten Haken, R. K., Eisbruch, A., & Kong, F. M. (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. Journal of Thoracic Oncology, 6(1), 71-78. https://doi.org/10.1097/JTO.0b013e3181f77b40