Physics and imaging in radiation oncology · 2025
Prospective validation of a pretreatment 18F-FDG PET/CT and mean lung dose model for early radiation pneumonitis.
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Thor Maria, Apte Aditya, Grkovski Milan, Simone Charles B, Gelblum Daphna Y, Zarepisheh Masoud, Iyengar Puneeth, Wu Abraham J, Shin Jacob Y, Chaunzwa Tafadzwa, Ma Jennifer, Billing David, Dunphy Mark, Chaft Jamie E, Gomez Daniel R, Deasy Joseph O, Shaverdian Narek
Аннотация
BACKGROUND AND PURPOSE: Early onset radiation pneumonitis (RPEarly) after concurrent chemoradiotherapy (cCRT) can lead to consolidation immunotherapy (IO) discontinuation, and poor survival in locally advanced non-small cell lung cancer (LA-NSCLC). This work assessed the external validity of a previously published RPEarly risk model.
MATERIAL AND METHODS: The RPEarly risk model utilizes pretreatment 18F-FDG PET/CT imaging of the normal lungs and the mean lung dose (MLD). The 90th percentile of the standardized uptake value (SUVP90) and the MLD model parameters from the previous derivation cohort (N = 160) were applied in the independent cohort (50 consecutive LA-NSCLC patients treated with cCRT and IO) where model performance was evaluated (area under the receiver-operating characteristic curve (AUC), p-values, and the Hosmer-Lemeshow test (pHL)).
RESULTS: Seven patients (14 %) developed RPEarly. Model performance of the previously developed SUVP90 and MLD model improved with re-fitting (AUC = 0.76 vs. 0.72; p = 0.01 vs. 0.10; pHL = 0.66 vs. 0.94). Above a clinically desirable 10 % predicted RPEarly, after refitting model coefficients in the combined derivation and validation cohorts (N = 210), the MLD was 13 ± 2.2 EQD23 Gy (SUVP90 = 1.2 ± 0.3) above the RPEarly risk threshold vs. 8.5 ± 2.6 EQD23 Gy (0.9 ± 0.2) below the threshold. For an SUVP90 of 1.1 and an MLD of 11 Gy EQD23 Gy, 25/27 patients developing RPEarly were captured.
CONCLUSION: The previously developed SUVP90 and MLD-based risk model for RPEarly demonstrated a high probability to correctly predict RPEarly in the independent cohort. This now validated RPEarly risk model with derived high-risk indications could enable personalized thoracic RT planning to reduce the risk of RPEarly and of discontinuing life-prolonging IO post-cCRT.
MATERIAL AND METHODS: The RPEarly risk model utilizes pretreatment 18F-FDG PET/CT imaging of the normal lungs and the mean lung dose (MLD). The 90th percentile of the standardized uptake value (SUVP90) and the MLD model parameters from the previous derivation cohort (N = 160) were applied in the independent cohort (50 consecutive LA-NSCLC patients treated with cCRT and IO) where model performance was evaluated (area under the receiver-operating characteristic curve (AUC), p-values, and the Hosmer-Lemeshow test (pHL)).
RESULTS: Seven patients (14 %) developed RPEarly. Model performance of the previously developed SUVP90 and MLD model improved with re-fitting (AUC = 0.76 vs. 0.72; p = 0.01 vs. 0.10; pHL = 0.66 vs. 0.94). Above a clinically desirable 10 % predicted RPEarly, after refitting model coefficients in the combined derivation and validation cohorts (N = 210), the MLD was 13 ± 2.2 EQD23 Gy (SUVP90 = 1.2 ± 0.3) above the RPEarly risk threshold vs. 8.5 ± 2.6 EQD23 Gy (0.9 ± 0.2) below the threshold. For an SUVP90 of 1.1 and an MLD of 11 Gy EQD23 Gy, 25/27 patients developing RPEarly were captured.
CONCLUSION: The previously developed SUVP90 and MLD-based risk model for RPEarly demonstrated a high probability to correctly predict RPEarly in the independent cohort. This now validated RPEarly risk model with derived high-risk indications could enable personalized thoracic RT planning to reduce the risk of RPEarly and of discontinuing life-prolonging IO post-cCRT.