A prospective observational study of Gallium-68 ventilation and perfusion PET/CT during and after radiotherapy in patients with non-small cell lung cancer

BMC Cancer

Shankar Siva¹  Jason Callahan²  Tomas Kron²  Olga A Martin²  Michael P MacManus¹  David L Ball¹  Rodney J Hicks³  Michael S Hofman³ 

[1] Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville 8006, Australia

[2] Division of Radiation Oncology and Cancer Imaging, St Andrews Place, East Melbourne 3002, Australia

[3] Department of Medicine, The University of Melbourne, Parkville 8006, Australia

关键词: Inflammatory cytokines;    Gamma-H2AX;    Biomarkers;    Biological dose escalation;    Adaptive radiotherapy;    4D;    Lung cancer;    Definitive radiation;    Positron emission tomography;   

Others  :  1121000
DOI  :  10.1186/1471-2407-14-740

 received in 2014-06-21, accepted in 2014-09-25,  发布年份 2014

【 摘 要 】

Background

Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancers, and is the leading cause of cancer deaths. Radiation therapy (RT), alone or in combination with chemotherapy, is the standard of care for curative intent treatment of patients with locally advanced or inoperable NSCLC. The ability to intensify treatment to achieve a better chance for cure is limited by the risk of injury to the surrounding lung.

Methods/Design

This is a prospective observational study of 60 patients with NSCLC receiving curative intent RT. Independent human ethics board approval was received from the Peter MacCallum Cancer Centre ethics committee. In this research, Galligas and Gallium-68 macroaggregated albumin (MAA) positron emission tomography (PET) imaging will be used to measure ventilation (V) and perfusion (Q) in the lungs. This is combined with computed tomography (CT) and both performed with a four dimensional (4D) technique that tracks respiratory motion. This state-of-the-art scan has superior resolution, accuracy and quantitative ability than previous techniques. The primary objective of this research is to observe changes in ventilation and perfusion secondary to RT as measured by 4D V/Q PET/CT. Additionally, we plan to model personalised RT plans based on an individual’s lung capacity. Increasing radiation delivery through areas of poorly functioning lung may enable delivery of larger, more effective doses to tumours without increasing toxicity. By performing a second 4D V/Q PET/CT scan during treatment, we plan to simulate biologically adapted RT depending on the individual’s accumulated radiation injury. Tertiary aims of the study are assess the prognostic significance of a novel combination of clinical, imaging and serum biomarkers in predicting for the risk of lung toxicity. These biomarkers include spirometry, 18 F-Fluorodeoxyglucose PET/CT, gamma-H2AX signals in hair and lymphocytes, as well as assessment of blood cytokines.

Discussion

By correlating these biomarkers to toxicity outcomes, we aim to identify those patients early who will not tolerate RT intensification during treatment. This research is an essential step leading towards the design of future biologically adapted radiotherapy strategies to mitigate the risk of lung injury during dose escalation for patients with locally advanced lung cancer.

Trials registration

Universal Trial Number (UTN) U1111-1138-4421.

【 授权许可】

   
2014 Siva et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

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