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Early Assessment of Treatment Responses During Radiation Therapy for Lung Cancer Using Quantitative Analysis of Daily Computed Tomography. Int J Radiat Oncol Biol Phys 2017 06 01;98(2):463-472

Date

05/04/2017

Pubmed ID

28463166

DOI

10.1016/j.ijrobp.2017.02.032

Scopus ID

2-s2.0-85018356175   11 Citations

Abstract

PURPOSE: To investigate early tumor and normal tissue responses during the course of radiation therapy (RT) for lung cancer using quantitative analysis of daily computed tomography (CT) scans.

METHODS AND MATERIALS: Daily diagnostic-quality CT scans acquired using CT-on-rails during CT-guided RT for 20 lung cancer patients were quantitatively analyzed. On each daily CT set, the contours of the gross tumor volume (GTV) and lungs were generated and the radiation dose delivered was reconstructed. The changes in CT image intensity (Hounsfield unit [HU]) features in the GTV and the multiple normal lung tissue shells around the GTV were extracted from the daily CT scans. The associations between the changes in the mean HUs, GTV, accumulated dose during RT delivery, and patient survival rate were analyzed.

RESULTS: During the RT course, radiation can induce substantial changes in the HU histogram features on the daily CT scans, with reductions in the GTV mean HUs (dH) observed in the range of 11 to 48 HU (median 30). The dH is statistically related to the accumulated GTV dose (R2 > 0.99) and correlates weakly with the change in GTV (R2 = 0.3481). Statistically significant increases in patient survival rates (P=.038) were observed for patients with a higher dH in the GTV. In the normal lung, the 4 regions proximal to the GTV showed statistically significant (P<.001) HU reductions from the first to last fraction.

CONCLUSION: Quantitative analysis of the daily CT scans indicated that the mean HUs in lung tumor and surrounding normal tissue were reduced during RT delivery. This reduction was observed in the early phase of the treatment, is patient specific, and correlated with the delivered dose. A larger HU reduction in the GTV correlated significantly with greater patient survival. The changes in daily CT features, such as the mean HU, can be used for early assessment of the radiation response during RT delivery for lung cancer.

Author List

Paul J, Yang C, Wu H, Tai A, Dalah E, Zheng C, Johnstone C, Kong FM, Gore E, Li XA

Authors

Elizabeth M. Gore MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Candice A. Johnstone MD, MPH Associate Professor in the Radiation Oncology department at Medical College of Wisconsin
X Allen Li PhD Professor in the Radiation Oncology department at Medical College of Wisconsin
An Tai PhD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Female
Four-Dimensional Computed Tomography
Humans
Lung
Lung Neoplasms
Male
Middle Aged
Radiotherapy Dosage
Radiotherapy, Image-Guided
Survival Rate
Time Factors
Treatment Outcome
Tumor Burden
jenkins-FCD Prod-480 9a4deaf152b0b06dd18151814fff2e18f6c05280