Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2015
The first patient treatment of computed tomography ventilation functional image-guided radiotherapy for lung cancer.
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Yamamoto Tokihiro, Kabus Sven, Bal Matthieu, Keall Paul, Benedict Stanley, Daly Megan
Аннотация
BACKGROUND AND PURPOSE: Radiotherapy that selectively avoids irradiating highly-functional lung regions may reduce pulmonary toxicity. We report on the first clinical implementation and patient treatment of lung functional image-guided radiotherapy using an emerging technology, computed tomography (CT) ventilation imaging.
MATERIAL AND METHODS: A protocol was developed to investigate the safety and feasibility of CT ventilation functional image-guided radiotherapy. CT ventilation imaging is based on (1) deformable image registration of four-dimensional (4D) CT images, and (2) quantitative image analysis for regional volume change, a surrogate for ventilation. CT ventilation functional image-guided radiotherapy plans were designed to minimize specific lung dose-function metrics, including functional V20 (fV20), while maintaining target coverage and meeting standard constraints to other critical organs.
RESULTS: CT ventilation functional image-guided treatment planning reduced the lung fV20 by 5% compared to an anatomic image-guided plan for an enrolled patient with stage IIIB non-small cell lung cancer. Although the doses to several other critical organs increased, the necessary constraints were all met.
CONCLUSIONS: An emerging technology, CT ventilation imaging has been translated into the clinic and used in functional image-guided radiotherapy for the first time. This milestone represents an important first step toward hypothetically reduced pulmonary toxicity in lung cancer radiotherapy.
MATERIAL AND METHODS: A protocol was developed to investigate the safety and feasibility of CT ventilation functional image-guided radiotherapy. CT ventilation imaging is based on (1) deformable image registration of four-dimensional (4D) CT images, and (2) quantitative image analysis for regional volume change, a surrogate for ventilation. CT ventilation functional image-guided radiotherapy plans were designed to minimize specific lung dose-function metrics, including functional V20 (fV20), while maintaining target coverage and meeting standard constraints to other critical organs.
RESULTS: CT ventilation functional image-guided treatment planning reduced the lung fV20 by 5% compared to an anatomic image-guided plan for an enrolled patient with stage IIIB non-small cell lung cancer. Although the doses to several other critical organs increased, the necessary constraints were all met.
CONCLUSIONS: An emerging technology, CT ventilation imaging has been translated into the clinic and used in functional image-guided radiotherapy for the first time. This milestone represents an important first step toward hypothetically reduced pulmonary toxicity in lung cancer radiotherapy.