Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan.
PLoS One. 2020 Dec 28;15(12):e0244143. doi: 10.1371/journal.pone.0244143. eCollection 2020.
The constraint values of dose-volume histogram (DVH) parameters for radiation pneumonitis (RP) prediction have not been uniform in previous studies. We compared the differences between conventional DVH parameters and DVH parameters with high attenuation volume (HAV) in CT imaging in both esophageal cancer and lung cancer patients to determine the most suitable DVH parameters in predicting RP onset. Seventy-seven and 72 patients who underwent radiation therapy for lung cancer and esophageal cancer, respectively, were retrospectively assessed. RP was valued according to the Common Terminology Criteria for Adverse Events. We quantified HAV with quantitative computed tomography analysis. We compared conventional DVH parameters and DVH parameters with HAV in both groups of patients. Then, the thresholds of DVH parameters that predicted symptomatic RP and the differences in threshold of DVH parameters between lung cancer and esophageal cancer patient groups were compared. The predictive performance of DVH parameters for symptomatic RP was compared using the area under the receiver operating characteristic curve. Mean lung dose, HAV30% (the proportion of the lung with HAV receiving ≥30 Gy), and HAV20% were the top three parameters in lung cancer, while HAV10%, HAV5%, and V10 (the percentage of lung volume receiving 10 Gy or more) were the top three in esophageal cancer. By comparing the differences in the threshold for parameters predicting RP between the two cancers, we saw that HAV30% retained the same value in both cancers. DVH parameters with HAV showed narrow differences in the threshold between the two cancer patient groups compared to conventional DVH parameters. DVH parameters with HAV may have higher commonality than conventional DVH parameters in both patient groups tested.
在先前的研究中，放射性肺炎（RP）预测的剂量-体积直方图（DVH）参数的约束值并不统一。我们比较了食管癌和肺癌患者 CT 成像中常规 DVH 参数和高衰减体积（HAV）DVH 参数之间的差异，以确定预测 RP 发作最适合的 DVH 参数。回顾性评估了分别接受肺癌和食管癌放射治疗的 77 名和 72 名患者。根据不良事件的通用术语标准评估 RP。我们使用定量 CT 分析来量化 HAV。我们比较了两组患者的常规 DVH 参数和 HAV 的 DVH 参数。然后，比较了预测有症状 RP 的 DVH 参数的阈值以及肺癌和食管癌患者组之间 DVH 参数阈值的差异。使用接收器操作特性曲线下的面积比较了 DVH 参数对有症状 RP 的预测性能。在肺癌中，平均肺剂量、HAV30%（接受≥30Gy 的 HAV 肺的比例）和 HAV20%是前三个参数，而 HAV10%、HAV5%和 V10（肺体积接受 10Gy 或更高的百分比）是食管癌的前三个参数。通过比较两种癌症预测 RP 参数阈值的差异，我们发现 HAV30%在两种癌症中具有相同的值。与常规 DVH 参数相比，具有 HAV 的 DVH 参数在两种癌症患者组之间的阈值差异较窄。在测试的两组患者中，具有 HAV 的 DVH 参数可能比常规 DVH 参数具有更高的共性。
