☆ 4.7 Article

Changes in Global Function and Regional Ventilation and Perfusion on SPECT During the Course of Radiotherapy in Patients With Non-Small-Cell Lung Cancer

INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS (2012)

Journal

INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS

Volume 82, Issue 4, Pages E631-E638

Publisher

ELSEVIER SCIENCE INC

DOI: 10.1016/j.ijrobp.2011.07.044

Keywords

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

Funding

ASCO-CDA Lance Armstrong Foundation [R21CA127057, P01 CA059827]
Shandong Provincial Health Bureau [2007QW036]
Foundation for Excellent Young Scientists of Shandong Province, China [BS2009YY012]
[NSFC30700196]
[NSFC81172133]

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Abstract

Purpose: This study aimed to (1) examine changes in dyspnea, global pulmonary function test (PFT) results, and functional activity on ventilation (V)/perfusion (Q) single-photon emission computerized tomography (SPECT) scans during the course of radiation (RT), and (2) factors associated with the changes in patients with non-small-cell lung cancer (NSCLC). Methods and Materials: Fifty-six stage I to III NSCLC patients treated with definitive RT with or without chemotherapy were enrolled prospectively. Dyspnea was graded according to Common Terminology Criteria for Adverse Events version 3.0 prior to and weekly during RT. V/Q SPECT-computed tomography (CT) and PFTs were performed prior to and during RT at approximately 45 Gy. Functions of V and Q activities were assessed using a semiquantitative scoring of SPECT images. Results: Breathing improved significantly at the third week (mean dyspnea grade, 0.8 vs. 0.6; paired t-test p = 0.011) and worsened during the later course of RT (p > 0.05). Global PFT results did not change significantly, while regional lung function on V/Q SPECT improved significantly after similar to 45 Gy. The V defect score (DS) was 4.9 pre-RT versus 4.3 during RT (p = 0.01); Q DS was 4.3 pre-RT versus 4.0 during RT (p < 0.01). Improvements in V and Q functions were seen primarily in the ipsilateral lung (V DS, 1.9 pre-RT versus 1.4 during RT, p < 0.01; Q DS, 1.7 pre-RT versus 1.5 during RT, p < 0.01). Baseline primarytumor volume was significantly correlated with pre-RT V/Q DS (p < 0.01). Patients with central lung tumors had greater interval changes in V and Q than those with more peripheral tumors (p < 0.05 for both V and Q DS). Conclusions: Regional ventilation and perfusion improved during RT at 45 Gy. This suggests that adaptive planning based on V/Q SPECT during RT may allow sparing of functionally recoverable lung tissue. (C) 2012 Elsevier Inc.

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Functional lung imaging in thoracic tumor radiotherapy: Application and progress

Pi-Xiao Zhou, Shu-Xu Zhang

Summary: Radiotherapy plays a crucial role in thoracic tumor treatment, but radiation-induced lung injury limits the increase in target doses. The introduction of functional lung imaging allows for the design of a functional lung protection plan, reducing the impact of radiation on functional lung and decreasing the occurrence of radiation-induced lung injury.

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