Lucia François, Bourhis David, Pinot Fanny, Hamya Mohamed, Goasduff Gaëlle, Blanc-Béguin Frédérique, Hennebicq Simon, Mauguen Maëlle, Kerleguer Kevin, Schick Ulrike, Consigny Maëlys, Pradier Olivier, Le Gal Grégoire, Salaun Pierre-Yves, Bourbonne Vincent, Le Roux Pierre-Yves
Radiation Oncology Department, University Hospital, Brest, France; LaTIM, INSERM, UMR 1101, University of Brest, Brest, France.
Service de Médecine Nucléaire, CHRU de Brest, Brest, France.
Int J Radiat Oncol Biol Phys. 2024 Mar 15;118(4):952-962. doi: 10.1016/j.ijrobp.2023.10.004. Epub 2023 Oct 22.
The aim of this work was to compare anatomic and functional dose-volume parameters as predictors of acute radiation-induced lung toxicity (RILT) in patients with lung tumors treated with stereotactic body radiation therapy.
Fifty-nine patients treated with stereotactic body radiation therapy were prospectively included. All patients underwent gallium 68 lung perfusion positron emission tomography (PET)/computed tomography (CT) imaging before treatment. Mean lung dose (MLD) and volumes receiving x Gy (VxGy, 5-30 Gy) were calculated in 5 lung volumes: the conventional anatomic volume (AV) delineated on CT images, 3 lung functional volumes (FVs) defined on lung perfusion PET imaging (FV50%, FV70%, and FV90%; ie, the minimal volume containing 50%, 70%, and 90% of the total activity within the AV), and a low FV (LFV; LFV = AV - FV90%). The primary endpoint of this analysis was grade ≥2 acute RILT at 3 months as assessed with National Cancer Institute Common Terminology Criteria for Adverse Events version 5. Dose-volume parameters in patients with and without acute RILT were compared. Receiver operating characteristic curves assessing the ability of dose-volume parameters to discriminate between patients with and without acute RILT were generated, and area under the curve (AUC) values were calculated.
Of the 59 patients, 10 (17%) had grade ≥2 acute RILT. The MLD and the VxGy in the AV and LFV were not statistically different between patients with and without acute RILT (P > .05). All functional parameters were significantly higher in acute RILT patients (P < .05). AUC values (95% CI) for MLD AV, LFV, FV50%, FV70%, and FV90% were 0.66 (0.46-0.85), 0.60 (0.39-0.80), 0.77 (0.63-0.91), 0.77 (0.64-0.91), and 0.75 (0.58-0.91), respectively. AUC values for V20Gy AV, LFV, FV50%, FV70%, and FV90% were 0.65 (0.44-0.87), 0.64 (0.46-0.83), 0.82 (0.69-0.95), 0.81 (0.67-0.96), and 0.75 (0.57-0.94), respectively.
The predictive value of PET perfusion-based functional parameters outperforms the standard CT-based dose-volume parameters for the risk of grade ≥2 acute RILT. Functional parameters could be useful for guiding radiation therapy planning and reducing the risk of acute RILT.
本研究旨在比较解剖学和功能剂量体积参数，以预测接受立体定向体部放射治疗的肺癌患者急性放射性肺损伤（RILT）。
前瞻性纳入59例接受立体定向体部放射治疗的患者。所有患者在治疗前均接受了镓68肺灌注正电子发射断层扫描（PET）/计算机断层扫描（CT）成像。在5个肺体积中计算平均肺剂量（MLD）和接受x Gy（VxGy，5 - 30 Gy）的体积：在CT图像上勾画的传统解剖体积（AV）、在肺灌注PET成像上定义的3个肺功能体积（FV）（FV50%、FV70%和FV90%；即包含AV内总活性50%、70%和90%的最小体积）以及低功能体积（LFV；LFV = AV - FV90%）。该分析的主要终点是按照美国国立癌症研究所不良事件通用术语标准第5版评估的3个月时≥2级急性RILT。比较有和无急性RILT患者的剂量体积参数。生成评估剂量体积参数区分有和无急性RILT患者能力的受试者操作特征曲线，并计算曲线下面积（AUC）值。
59例患者中，10例（17%）发生≥2级急性RILT。有和无急性RILT患者的AV和LFV中的MLD和VxGy无统计学差异（P > 0.05）。急性RILT患者的所有功能参数均显著更高（P < 0.05）。MLD AV、LFV、FV50%、FV70%和FV90%的AUC值（95% CI）分别为0.66（0.46 - 0.85）、0.60（0.39 - 0.80）、0.77（0.63 - 0.91）、0.77（0.64 - 0.91）和0.75（0.58 - 0.91）。V20Gy AV、LFV、FV50%、FV70%和FV90%的AUC值分别为：0.65（0.44 - 0.87）、0.64（0.46 - 0.83）、0.82（0.69 - 0.95）、0.81（0.67 - 0.96）和0.75（0.57 - 0.94）。
基于PET灌注的功能参数对于≥2级急性RILT风险的预测价值优于基于标准CT的剂量体积参数。功能参数可能有助于指导放射治疗计划制定并降低急性RILT风险。
