Optimal beam arrangement for pulmonary ventilation image-guided intensity-modulated radiotherapy for lung cancer

Radiation Oncology

Bin Qi¹  Rijie Tang²  Guoqian Zhang³  Shengqu Lin³  Hui Yu³  Shuxu Zhang³  Ruihao Wang³ 

[1] Departments of Radiation Oncology, Cancer Hospital of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou 510095, China;Departments of Radiology, Cancer Hospital of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou 510095, China;Departments of Radiotherapy, Cancer Hospital of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou 510095, China

关键词: Plan optimization;    Four-dimensional computed tomography;    Pulmonary ventilation;    Intensity-modulated radiotherapy;   

Others  :  1151794
DOI  :  10.1186/1748-717X-9-184

 received in 2013-10-10, accepted in 2014-08-07,  发布年份 2014

【 摘 要 】

Background

The principal aim of this study was to evaluate the feasibility of incorporating four-dimensional (4D)-computed tomography (CT)-based functional information into treatment planning and to evaluate the potential benefits of individualized beam setups to better protect lung functionality in patients with non-small cell lung cancer (NSCLC).

Methods

Peak-exhale and peak-inhale CT scans were carried out in 16 patients with NSCLC treated with intensity-modulated radiotherapy (IMRT). 4D-CT-based ventilation information was generated from the two sets of CT images using deformable image registration. Four kinds of IMRT plans were generated for each patient: two anatomic plans without incorporation of ventilation information, and two functional plans with ventilation information, using either five equally spaced beams (FESB) or five manually optimized beams (FMOB). The dosimetric parameters of the plans were compared in terms of target and normal tissue structures, with special focus on dose delivered to total lung and functional lung.

Results

In both the anatomic and functional plans, the percentages of both the functional and total lung regions irradiated at V₅, V₁₀, and V₂₀ (percentage volume irradiated to >5, >10 and >20 Gy, respectively) were significantly lower for FMOB compared with FESB (P < 0.05), but there was no significant difference for V₃₀ (P > 0.05). Compared with FESB, a greater degree of sparing of the functional lung was achieved in functional IMRT plans with optimal beam arrangement, without compromising target volume coverage or the irradiated volume of organs at risk, such as the spinal cord, esophagus, and heart.

Conclusions

Pulmonary ventilation image-guided IMRT planning with further optimization of beam arrangements improves the preservation of functional lung in patients with NSCLC.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Mazeron R, Etienne-Mastroianni B, Perol D, Arpin D, Vincent M, Falchero L, Martel-Lafay I, Carrie C, Claude L: Predictive factors of late radiation fibrosis: a prospective study in non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2010, 77:38-43.
• [2]Ding X, Ji W, Li J, Zhang X, Wang L: Radiation recall pneumonitis induced by chemotherapy after thoracic radiotherapy for lung cancer. Radiat Oncol 2011, 6:24.
• [3]Mehta V: Radiation pneumonitis and pulmonary fibrosis in non-small-cell lung cancer: pulmonary function, prediction, and prevention. Int J Radiat Oncol Biol Phys 2005, 63:5-24.
• [4]Park YH, Kim JS: Predictors of radiation pneumonitis and pulmonary function changes after concurrent chemoradiotherapy of non-small cell lung cancer. Radiat Oncol J 2013, 31:34-40.
• [5]Graham MV, Purdy JA, Emami B, Harms W, Bosch W, Lockett MA, Perez CA: Clinical dose–volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 1999, 45:323-329.
• [6]Murshed H, Liu HH, Liao Z, Barker JL, Wang X, Tucker SL, Chandra A, Guerrero T, Stevens C, Chang JY, Jeter M, Cox JD, Komaki R, Mohan R: Dose and volume reduction for normal lung using intensity-modulated radiotherapy for advanced-stage non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004, 58(4):1258-1267.
• [7]Shioyama Y, Jang SY, Liu HH, Guerrero T, Wang X, Gayed IW, Erwin WD, Liao Z, Chang JY, Jeter M, Yaremko BP, Borghero YO, Cox JD, Komaki R, Mohan R: Preserving functional lung using perfusion imaging and intensity-modulated radiation therapy for advanced-stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2007, 68:1349-1358.
• [8]Castillo R, Castillo E, Martinez J, Guerrero T: Ventilation from four-dimensional computed tomography: density versus Jacobian methods. Phys Med Biol 2010, 55:4661-4685.
• [9]van Beek EJR, Wild JM, Kauczor H-U, Schreiber W, Mugler JP, de Lange EE: Functional MRI of the lung using hyperpolarized 3-helium gas. J Magn Reson Imaging 2004, 20:540-554.
• [10]Fain S, Schiebler ML, McCormack DG, Parraga G: Imaging of lung function using hyperpolarized helium-3 magnetic resonance imaging: Review of current and emerging translational methods and applications. J Magn Reson Imaging 2010, 32:1398-1408.
• [11]Gur D, Shabason L, Borovetz HS, Herbert DL, Reece GJ, Kennedy WH, Serago C: Regional Pulmonary Ventilation Measurements by Xenon Enhanced Dynamic Computed Tomography: An Update. J Comput Assist Tomog 1981, 5:678-683.
• [12]Yamamoto T, Kabus S, Klinder T, Lorenz C, von Berg J, Blaffert T, Loo BW Jr, Keall PJ: Investigation of four-dimensional computed tomography-based pulmonary ventilation imaging in patients with emphysematous lung regions. Phys Med Biol 2011, 56:2279-2298.
• [13]Rietzel E, Pan T, Chen GTY: Four-dimensional computed tomography: Image formation and clinical protocol. Med Phys 2005, 32:874-889.
• [14]Ding K, Bayouth JE, Buatti JM, Christensen GE, Reinhardt JM: 4DCT-based measurement of changes in pulmonary function following a course of radiation therapy. Med Phys 2010, 37:1261-1272.
• [15]Yamamoto T, Kabus S, von Berg J, Lorenz C, Keall PJ: Impact of four-dimensional computed tomography pulmonary ventilation imaging-based functional avoidance for lung cancer radiotherapy. Int J Radiat Oncol Biol Phys 2011, 79:279-288.
• [16]Yaremko BP, Guerrero TM, Noyola-Martinez J, Guerra R, Lege DG, Nguyen LT, Balter PA, Cox JD, Komaki R: Reduction of normal lung irradiation in locally advanced non-small-cell lung cancer patients, using ventilation images for functional avoidance. Int J Radiat Oncol Biol Phys 2007, 68:562-571.
• [17]Yu H, Zhang SX, Wang RH, Zhang GQ, Tan JM: The feasibility of mapping dose distribution of 4DCT images with deformable image registration in lung. Biomed Mater Eng 2014, 24:145-153.
• [18]Sorzano CO, Thévenaz P, Unser M: Elastic registration of biological images using vector-spline regularization. IEEE Trans Biomed Eng 2005, 52:652-663.
• [19]Reinhardt JM, Ding K, Cao K, Christensen GE, Hoffman EA, Bodas SV: Registration-based estimates of local lung tissue expansion compared to xenon CT measures of specific ventilation. Med Image Anal 2008, 12:752-763.
• [20]Kim M, Lee J, Ha B, Lee R, Lee KJ, Suh HS: Factors predicting radiation pneumonitis in locally advanced non-small cell lung cancer. Radiat Oncol J 2011, 29(3):181-190.
• [21]Yin Y, Chen JH, Li BS, Liu TH, Lu J, Bai T, Dong XL, Yu JM: Protection of lung function by introducing single photon emission computed tomography lung perfusion image into radiotherapy plan of lung cancer. Chin med J (Engl) 2009, 122:509-513.
• [22]Huang TC, Hsiao CY, Chien CR, Liang JA, Shih TC, Zhang GG: IMRT treatment plans and functional planning with functional lung imaging from 4D-CT for thoracic cancer patients. Radiat Oncol 2013, 8:3.
• [23]Guerrero T, Sanders K, Castillo E, Zhang Y, Bidaut L, Pan T, Komaki R: Dynamic ventilation imaging from four-dimensional computed tomography. Phys Med Biol 2006, 51:777-791.
• [24]Guerrero T, Sanders K, Noyola-Martinez J, Castillo E, Zhang Y, Tapia R, Guerra R, Borghero Y, Komaki R: Quantification of regional ventilation from treatment planning CT. Int J Radiat Oncol Biol Phys 2005, 62:630-634.
• [25]Seppenwoolde Y, Muller SH, Theuws JC, Baas P, Belderbos JS, Boersma LJ, Lebesque JV: Radiation dose-effect relations and local recovery in perfusion for patients with non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2000, 47:681-690.