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• W2023372965 abstract "Purpose/Objective(s)To prospectively investigate the ability of functional image-guided radiation therapy planning in lung cancer patients.Materials/MethodsFifty-two patients with advanced lung cancer were included in this study. Thirty-nine non-small-cell lung cancer patients underwent three-dimensional conformal radiation therapy (3D-CRT; median dose 74 Gy in 37 fractions) and 13 patients with small-cell lung cancer received accelerated hyperfractionated radiation therapy (median dose 45 Gy in 30 fractions). The functional images defined as pulmonary ventilation imaging using four-dimensional computed tomography (4D-CT) and pulmonary perfusion imaging in this study. Pulmonary ventilation images were derived from the low attenuation area (LAA) based on 4D-CT. The LAA was generated from 10-phase 4D-CT data sets according to CT numbers lower than different thresholds (-860, and -910 Hounsfield units). The functional lung image was defined as the area where LAA was excluded from an image of the total lung (LAA-860 and- 910). Pulmonary perfusion images at the 10-, 30-, 50-, and 70-percentile perfusion levels (F10, F30, F50, and F70 lung, respectively) were defined as the top 10%, 30%, 50%, and 70% of the normal lung volume, respectively, with hyperperfusion. Each image was incorporated into a 3D-CRT planning system for all patients, and evaluated as follows; 1) Comparison of the percentage of functional lung volume with total lung volume and incidence of radiation pneumonitis (RP); 2) Comparison of dosimetric parameters (V5- 30, and fV5-30: the percentage of total and functional lung volume irradiated with >5- 30 Gy or Mean lung dose (MLD), fMLD: mean dose administered to total or functional lung and the incidence of RP. RP was evaluated using the CTCAE ver 4.0. Statistical significance was defined as p < 0.05.ResultsGrade 1, 2, and ≥ 3 RP was observed in 13, 32, and 6 patents, respectively during a median 12 month follow-up. The mean percentages of LAA-860 and -910 in patients with grade ≥ 3 RP were significantly lower than those of grade 1or 2 RP (LAA-860, 48.0% vs 66.7%, p = 0.024, LAA-910, 75.2% vs 91.4%, p = 0.0032). There were no significant differences in F10-70. There were significant differences of univariate analysis assessing the incidence of grade ≥ 2 RP and V5- 30 (fV5- 30) or MLD (fMLD) in total lung and each functional lung as follows; in total lung, V20 > 30% (p = 0.039), V30 > 20% (p = 0.0111), and MLD > 15 Gy (p = 0.0141), and in F10, fV30 > 20% (p = 0.0422), in F30, fV30 > 20% (p = 0.0305), fMLD > 15 Gy (p = 0.0498), in LAA-860, fV30 > 20% (p = 0.0266), fMLD > 15 Gy (p = 0.0223), in LAA-910, fV30 > 20% (p = 0.0107), fMLD > 15 Gy (p = 0.0183), respectively.ConclusionsFunctional image-guided radiation therapy planning appears to predict risk factors for RP and may be effective in preserving functional lungs to reduce the incidence of severe RP in future. Purpose/Objective(s)To prospectively investigate the ability of functional image-guided radiation therapy planning in lung cancer patients. To prospectively investigate the ability of functional image-guided radiation therapy planning in lung cancer patients. Materials/MethodsFifty-two patients with advanced lung cancer were included in this study. Thirty-nine non-small-cell lung cancer patients underwent three-dimensional conformal radiation therapy (3D-CRT; median dose 74 Gy in 37 fractions) and 13 patients with small-cell lung cancer received accelerated hyperfractionated radiation therapy (median dose 45 Gy in 30 fractions). The functional images defined as pulmonary ventilation imaging using four-dimensional computed tomography (4D-CT) and pulmonary perfusion imaging in this study. Pulmonary ventilation images were derived from the low attenuation area (LAA) based on 4D-CT. The LAA was generated from 10-phase 4D-CT data sets according to CT numbers lower than different thresholds (-860, and -910 Hounsfield units). The functional lung image was defined as the area where LAA was excluded from an image of the total lung (LAA-860 and- 910). Pulmonary perfusion images at the 10-, 30-, 50-, and 70-percentile perfusion levels (F10, F30, F50, and F70 lung, respectively) were defined as the top 10%, 30%, 50%, and 70% of the normal lung volume, respectively, with hyperperfusion. Each image was incorporated into a 3D-CRT planning system for all patients, and evaluated as follows; 1) Comparison of the percentage of functional lung volume with total lung volume and incidence of radiation pneumonitis (RP); 2) Comparison of dosimetric parameters (V5- 30, and fV5-30: the percentage of total and functional lung volume irradiated with >5- 30 Gy or Mean lung dose (MLD), fMLD: mean dose administered to total or functional lung and the incidence of RP. RP was evaluated using the CTCAE ver 4.0. Statistical significance was defined as p < 0.05. Fifty-two patients with advanced lung cancer were included in this study. Thirty-nine non-small-cell lung cancer patients underwent three-dimensional conformal radiation therapy (3D-CRT; median dose 74 Gy in 37 fractions) and 13 patients with small-cell lung cancer received accelerated hyperfractionated radiation therapy (median dose 45 Gy in 30 fractions). The functional images defined as pulmonary ventilation imaging using four-dimensional computed tomography (4D-CT) and pulmonary perfusion imaging in this study. Pulmonary ventilation images were derived from the low attenuation area (LAA) based on 4D-CT. The LAA was generated from 10-phase 4D-CT data sets according to CT numbers lower than different thresholds (-860, and -910 Hounsfield units). The functional lung image was defined as the area where LAA was excluded from an image of the total lung (LAA-860 and- 910). Pulmonary perfusion images at the 10-, 30-, 50-, and 70-percentile perfusion levels (F10, F30, F50, and F70 lung, respectively) were defined as the top 10%, 30%, 50%, and 70% of the normal lung volume, respectively, with hyperperfusion. Each image was incorporated into a 3D-CRT planning system for all patients, and evaluated as follows; 1) Comparison of the percentage of functional lung volume with total lung volume and incidence of radiation pneumonitis (RP); 2) Comparison of dosimetric parameters (V5- 30, and fV5-30: the percentage of total and functional lung volume irradiated with >5- 30 Gy or Mean lung dose (MLD), fMLD: mean dose administered to total or functional lung and the incidence of RP. RP was evaluated using the CTCAE ver 4.0. Statistical significance was defined as p < 0.05. ResultsGrade 1, 2, and ≥ 3 RP was observed in 13, 32, and 6 patents, respectively during a median 12 month follow-up. The mean percentages of LAA-860 and -910 in patients with grade ≥ 3 RP were significantly lower than those of grade 1or 2 RP (LAA-860, 48.0% vs 66.7%, p = 0.024, LAA-910, 75.2% vs 91.4%, p = 0.0032). There were no significant differences in F10-70. There were significant differences of univariate analysis assessing the incidence of grade ≥ 2 RP and V5- 30 (fV5- 30) or MLD (fMLD) in total lung and each functional lung as follows; in total lung, V20 > 30% (p = 0.039), V30 > 20% (p = 0.0111), and MLD > 15 Gy (p = 0.0141), and in F10, fV30 > 20% (p = 0.0422), in F30, fV30 > 20% (p = 0.0305), fMLD > 15 Gy (p = 0.0498), in LAA-860, fV30 > 20% (p = 0.0266), fMLD > 15 Gy (p = 0.0223), in LAA-910, fV30 > 20% (p = 0.0107), fMLD > 15 Gy (p = 0.0183), respectively. Grade 1, 2, and ≥ 3 RP was observed in 13, 32, and 6 patents, respectively during a median 12 month follow-up. The mean percentages of LAA-860 and -910 in patients with grade ≥ 3 RP were significantly lower than those of grade 1or 2 RP (LAA-860, 48.0% vs 66.7%, p = 0.024, LAA-910, 75.2% vs 91.4%, p = 0.0032). There were no significant differences in F10-70. There were significant differences of univariate analysis assessing the incidence of grade ≥ 2 RP and V5- 30 (fV5- 30) or MLD (fMLD) in total lung and each functional lung as follows; in total lung, V20 > 30% (p = 0.039), V30 > 20% (p = 0.0111), and MLD > 15 Gy (p = 0.0141), and in F10, fV30 > 20% (p = 0.0422), in F30, fV30 > 20% (p = 0.0305), fMLD > 15 Gy (p = 0.0498), in LAA-860, fV30 > 20% (p = 0.0266), fMLD > 15 Gy (p = 0.0223), in LAA-910, fV30 > 20% (p = 0.0107), fMLD > 15 Gy (p = 0.0183), respectively. ConclusionsFunctional image-guided radiation therapy planning appears to predict risk factors for RP and may be effective in preserving functional lungs to reduce the incidence of severe RP in future. Functional image-guided radiation therapy planning appears to predict risk factors for RP and may be effective in preserving functional lungs to reduce the incidence of severe RP in future." @default.
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• W2023372965 title "A Prospective Study of Functional Image Guided Radiation Therapy Planning in Lung Cancer Patients" @default.
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