Journal of applied clinical medical physics · 2026
Characterization of dosimetric predictors for pulmonary perfusion changes before and after hypofractionated whole-breast radiotherapy in node-negative breast cancer patients: A prospective study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Allaveisi Farzaneh, Esmaeilzadeh Nima, Derakhshan Siamak, Jamshidi Dizaji Smaneh, Azadnia Aian
Аннотация
BACKGROUND: Breast cancer is the most common malignancy in women, and adjuvant radiotherapy is an essential component of curative treatment. Despite advances in hypofractionated whole-breast irradiation (HF-WBI), incidental lung exposure remains unavoidable and predisposes to radiation-induced pulmonary injury, including radiation pneumonitis (RP). Traditional predictors such as mean lung dose (MLD) may inadequately capture the heterogeneous intrapulmonary dose distribution typical of breast radiotherapy.
PURPOSE: The purpose of this study was to evaluate whether heterogeneity-sensitive dosimetric metrics and functional lung imaging better predict radiation-induced perfusion changes and RP in patients undergoing HF-WBI.
METHODS: In this prospective study, 48 node-negative breast cancer patients treated with conformal HF-WBI were evaluated. Pulmonary perfusion scans (PPS) were acquired pre-RT and 6-9 months post-RT. Dose-volume histogram (DVH) parameters, including MLD, uniform effective dose (Deff), and V5-V40, were extracted from three-dimensional conformal radiotherapy (3DCRT) or forward-planned intensity-modulated RT (FIMRT) plans. Deff was calculated using the Lyman-Kutcher-Burman (LKB) model to integrate dose heterogeneity. Associations between dosimetric metrics, perfusion changes, and RP were analyzed using correlation and ROC analysis.
RESULTS: PPS revealed modest but detectable post-RT perfusion declines, most pronounced in lung regions receiving higher doses. Three patients (6.3%) developed Grade 2 RP. Deff and high-dose lung volumes (V35-V40) demonstrated the strongest correlations with perfusion loss and RP (AUC 0.81-0.85, p < 0.01), whereas MLD showed weaker predictive value. ROC analysis identified clinically relevant thresholds: Deff ≤ 13.6 Gy, V35 ≤ 37.5%, V40 ≤ 32%, and a ≥4% decline in total perfusion, below which minimal functional impairment and RP were observed.
CONCLUSIONS: Deff and high-dose volumetric constraints outperform MLD in predicting decrease in lung perfusion in HF-WBI. Quantitative PPS provides complementary functional validation, and integration of dosimetric and functional parameters may refine lung-sparing strategies in breast radiotherapy.
PURPOSE: The purpose of this study was to evaluate whether heterogeneity-sensitive dosimetric metrics and functional lung imaging better predict radiation-induced perfusion changes and RP in patients undergoing HF-WBI.
METHODS: In this prospective study, 48 node-negative breast cancer patients treated with conformal HF-WBI were evaluated. Pulmonary perfusion scans (PPS) were acquired pre-RT and 6-9 months post-RT. Dose-volume histogram (DVH) parameters, including MLD, uniform effective dose (Deff), and V5-V40, were extracted from three-dimensional conformal radiotherapy (3DCRT) or forward-planned intensity-modulated RT (FIMRT) plans. Deff was calculated using the Lyman-Kutcher-Burman (LKB) model to integrate dose heterogeneity. Associations between dosimetric metrics, perfusion changes, and RP were analyzed using correlation and ROC analysis.
RESULTS: PPS revealed modest but detectable post-RT perfusion declines, most pronounced in lung regions receiving higher doses. Three patients (6.3%) developed Grade 2 RP. Deff and high-dose lung volumes (V35-V40) demonstrated the strongest correlations with perfusion loss and RP (AUC 0.81-0.85, p < 0.01), whereas MLD showed weaker predictive value. ROC analysis identified clinically relevant thresholds: Deff ≤ 13.6 Gy, V35 ≤ 37.5%, V40 ≤ 32%, and a ≥4% decline in total perfusion, below which minimal functional impairment and RP were observed.
CONCLUSIONS: Deff and high-dose volumetric constraints outperform MLD in predicting decrease in lung perfusion in HF-WBI. Quantitative PPS provides complementary functional validation, and integration of dosimetric and functional parameters may refine lung-sparing strategies in breast radiotherapy.