Evaluating the Toxicity Reduction With Computed Tomographic Ventilation Functional Avoidance Radiation Therapy

Austin M. Faught, Yuya Miyasaka, Noriyuki Kadoya, Richard Castillo, Edward Castillo, Yevgeniy Vinogradskiy, Tokihiro Yamamoto

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose Computed tomographic (CT) ventilation imaging is a new modality that uses 4-dimensional (4D) CT information to calculate lung ventilation. Although retrospective studies have reported on the reduction in dose to functional lung, no work to our knowledge has been published in which the dosimetric improvements have been translated to a reduction in the probability of pulmonary toxicity. Our work estimates the reduction in toxicity for CT ventilation–based functional avoidance planning. Methods and Materials Seventy previously treated lung cancer patients who underwent 4DCT imaging were used for the study. CT ventilation maps were calculated with 4DCT deformable image registration and a density change–based algorithm. Pneumonitis was graded on the basis of imaging and clinical presentation. Maximum likelihood methods were used to generate normal tissue complication probability (NTCP) models predicting grade 2 or higher (2+) and grade 3+ pneumonitis as a function of dose (V5 Gy, V10 Gy, V20 Gy, V30 Gy, and mean dose) to functional lung. For 30 patients a functional plan was generated with the goal of reducing dose to the functional lung while meeting Radiation Therapy Oncology Group 0617 constraints. The NTCP models were applied to the functional plans and the clinically used plans to calculate toxicity reduction. Results By the use of functional avoidance planning, absolute reductions in grade 2+ NTCP of 6.3%, 7.8%, and 4.8% were achieved based on the mean fV20 Gy, fV30 Gy, and mean dose to functional lung metrics, respectively. Absolute grade 3+ NTCP reductions of 3.6%, 4.8%, and 2.4% were achieved with fV20 Gy, fV30 Gy, and mean dose to functional lung. Maximum absolute reductions of 52.3% and 16.4% were seen for grade 2+ and grade 3+ pneumonitis for individual patients. Conclusion Our study quantifies the possible toxicity reduction from CT ventilation–based functional avoidance planning. Reductions in grades 2+ and 3+ pneumonitis were 7.1% and 4.7% based on mean dose-function metrics, with reductions as high as 52.3% for individual patients. Our work provides seminal data for determining the potential toxicity benefit from incorporating CT ventilation into thoracic treatment planning.

Original languageEnglish (US)
Pages (from-to)325-333
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume99
Issue number2
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

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avoidance
ventilation
toxicity
Ventilation
radiation therapy
Radiotherapy
lungs
Lung
grade
Pneumonia
dosage
planning
Radiation Oncology
Lung Neoplasms
Thorax
Retrospective Studies
cancer

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Evaluating the Toxicity Reduction With Computed Tomographic Ventilation Functional Avoidance Radiation Therapy. / Faught, Austin M.; Miyasaka, Yuya; Kadoya, Noriyuki; Castillo, Richard; Castillo, Edward; Vinogradskiy, Yevgeniy; Yamamoto, Tokihiro.

In: International Journal of Radiation Oncology Biology Physics, Vol. 99, No. 2, 01.10.2017, p. 325-333.

Research output: Contribution to journalArticle

Faught, Austin M. ; Miyasaka, Yuya ; Kadoya, Noriyuki ; Castillo, Richard ; Castillo, Edward ; Vinogradskiy, Yevgeniy ; Yamamoto, Tokihiro. / Evaluating the Toxicity Reduction With Computed Tomographic Ventilation Functional Avoidance Radiation Therapy. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 99, No. 2. pp. 325-333.
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abstract = "Purpose Computed tomographic (CT) ventilation imaging is a new modality that uses 4-dimensional (4D) CT information to calculate lung ventilation. Although retrospective studies have reported on the reduction in dose to functional lung, no work to our knowledge has been published in which the dosimetric improvements have been translated to a reduction in the probability of pulmonary toxicity. Our work estimates the reduction in toxicity for CT ventilation–based functional avoidance planning. Methods and Materials Seventy previously treated lung cancer patients who underwent 4DCT imaging were used for the study. CT ventilation maps were calculated with 4DCT deformable image registration and a density change–based algorithm. Pneumonitis was graded on the basis of imaging and clinical presentation. Maximum likelihood methods were used to generate normal tissue complication probability (NTCP) models predicting grade 2 or higher (2+) and grade 3+ pneumonitis as a function of dose (V5 Gy, V10 Gy, V20 Gy, V30 Gy, and mean dose) to functional lung. For 30 patients a functional plan was generated with the goal of reducing dose to the functional lung while meeting Radiation Therapy Oncology Group 0617 constraints. The NTCP models were applied to the functional plans and the clinically used plans to calculate toxicity reduction. Results By the use of functional avoidance planning, absolute reductions in grade 2+ NTCP of 6.3{\%}, 7.8{\%}, and 4.8{\%} were achieved based on the mean fV20 Gy, fV30 Gy, and mean dose to functional lung metrics, respectively. Absolute grade 3+ NTCP reductions of 3.6{\%}, 4.8{\%}, and 2.4{\%} were achieved with fV20 Gy, fV30 Gy, and mean dose to functional lung. Maximum absolute reductions of 52.3{\%} and 16.4{\%} were seen for grade 2+ and grade 3+ pneumonitis for individual patients. Conclusion Our study quantifies the possible toxicity reduction from CT ventilation–based functional avoidance planning. Reductions in grades 2+ and 3+ pneumonitis were 7.1{\%} and 4.7{\%} based on mean dose-function metrics, with reductions as high as 52.3{\%} for individual patients. Our work provides seminal data for determining the potential toxicity benefit from incorporating CT ventilation into thoracic treatment planning.",
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