The first patient treatment of computed tomography ventilation functional image-guided radiotherapy for lung cancer. Issue 2 (February 2016)

• Record Type: Journal Article
• Authors: Yamamoto, Tokihiro; Kabus, Sven; Bal, Matthieu; Keall, Paul; Benedict, Stanley; Daly, Megan
• Is Part Of: Radiotherapy and oncology. Volume 118:Issue 2(2016:Feb.)
• Page Start: 227
• Page End: 231
• Publication Date: 2016-02
• Subjects: Lung cancer -- Radiation pneumonitis -- Lung functional imaging -- 4D CT -- Deformable image registration; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2015.11.006
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Background and purpose: Radiotherapy that selectively avoids irradiating highly-functional lung regions may reduce pulmonary toxicity. We report on the first clinical implementation and patient treatment of lung functional image-guided radiotherapy using an emerging technology, computed tomography (CT) ventilation imaging. Material and methods: A protocol was developed to investigate the safety and feasibility of CT ventilation functional image-guided radiotherapy. CT ventilation imaging is based on (1) deformable image registration of four-dimensional (4D) CT images, and (2) quantitative image analysis for regional volume change, a surrogate for ventilation. CT ventilation functional image-guided radiotherapy plans were designed to minimize specific lung dose–function metrics, including functional V 20 (f V 20 ), while maintaining target coverage and meeting standard constraints to other critical organs. Results: CT ventilation functional image-guided treatment planning reduced the lung f V 20 by 5% compared to an anatomic image-guided plan for an enrolled patient with stage IIIB non-small cell lung cancer. Although the doses to several other critical organs increased, the necessary constraints were all met. Conclusions: An emerging technology, CT ventilation imaging has been translated into the clinic and used in functional image-guided radiotherapy for the first time. This milestone represents an important first step toward hypothetically reduced pulmonary toxicity in lung cancer radiotherapy.