Hwang Jeongeun, Kim Hakyoung, Kim Sun Myung, Yang Dae Sik
Department of Medical IT Engineering, Soonchunhyang University, Asan 31538, Chungcheongnam-do, Republic of Korea.
Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea.
Life (Basel). 2024 Jul 19;14(7):897. doi: 10.3390/life14070897.
Idiopathic pulmonary fibrosis (IPF) has the potential to cause fatal pulmonary toxicity after radiotherapy and can increase the morbidity and mortality of non-small-cell lung cancer (NSCLC) patients. In this context, we aimed to develop imaging complexity biomarkers to predict the incidence of severe pulmonary toxicity in patients with NSCLC who have underlying IPF and are treated with radiotherapy. We retrospectively reviewed the medical records of 19 patients with NSCLC who had underlying IPF and were treated with radiotherapy at the Korea University Guro Hospital between March 2018 and December 2022. To quantify the morphometric complexity of the lung parenchyma, box-counting fractal dimensions and lacunarity analyses were performed on pre-radiotherapy simulation chest computed tomography scans. Of the 19 patients, the incidence of grade 3 or higher radiation pneumonitis was observed in 8 (42.1%). After adjusting for age, sex, smoking status, histology, and diffusing capacity of the lung for carbon monoxide, eight patients with a lower fractal dimension showed a significantly higher hazard ratio of 7.755 (1.168-51.51) for grade 3 or higher pneumonitis than those with a higher fractal dimension. Patients with lower lacunarity exhibited significantly lower hazards in all models, both with and without adjustments. The lower-than-median lacunarity group also showed significantly lower incidence curves for all models built in this study. We devised a technique for quantifying morphometric complexity in NSCLC patients with IPF on radiotherapy and discovered lacunarity as a potential imaging biomarker for grade 3 or higher pneumonitis.
特发性肺纤维化（IPF）在放疗后有可能导致致命的肺部毒性，并会增加非小细胞肺癌（NSCLC）患者的发病率和死亡率。在此背景下，我们旨在开发影像复杂性生物标志物，以预测患有潜在IPF且接受放疗的NSCLC患者发生严重肺部毒性的几率。我们回顾性分析了2018年3月至2022年12月期间在韩国大学古罗医院接受放疗的19例患有潜在IPF的NSCLC患者的病历。为了量化肺实质的形态计量复杂性，我们对放疗前模拟胸部计算机断层扫描进行了盒计数分形维数和孔隙率分析。在这19例患者中，8例（42.1%）出现了3级或更高等级的放射性肺炎。在调整了年龄、性别、吸烟状况、组织学类型和肺一氧化碳弥散量后，8例分形维数较低的患者发生3级或更高等级肺炎的风险比为7.755（1.168 - 51.51），显著高于分形维数较高的患者。在所有模型中，无论是否进行调整，孔隙率较低的患者风险均显著较低。低于中位数孔隙率组在本研究构建的所有模型中发病率曲线也显著较低。我们设计了一种技术来量化接受放疗的IPF合并NSCLC患者的形态计量复杂性，并发现孔隙率是3级或更高等级肺炎的潜在影像生物标志物。
