Evaluation of lung toxicity risk with computed tomography ventilation image for thoracic cancer patients

Masakazu Otsuka, Hajime Monzen, Kenji Matsumoto, Mikoto Tamura, Masahiro Inada, Noriyuki Kadoya, Yasumasa Nishimura

研究成果: Article査読

1 被引用数 (Scopus)


Background Four-dimensional computed tomography (4D-CT) ventilation is an emerging imaging modality. Functional avoidance of regions according to 4D-CT ventilation may reduce lung toxicity after radiation therapy. This study evaluated associations between 4D-CT ventilation-based dosimetric parameters and clinical outcomes. Methods Pre-treatment 4D-CT data were used to retrospectively construct ventilation images for 40 thoracic cancer patients retrospectively. Fifteen patients were treated with conventional radiation therapy, 6 patients with hyperfractionated radiation therapy and 19 patients with stereotactic body radiation therapy (SBRT). Ventilation images were calculated from 4D-CT data using a deformable image registration and Jacobian-based algorithm. Each ventilation map was normalized by converting it to percentile images. Ventilation-based dosimetric parameters (Mean Dose, V5 [percent lung volume receiving ≥5 Gy], and V20 [percent lung volume receiving ≥20 Gy]) were calculated for highly and poorly ventilated regions. To test whether the ventilation-based dosimetric parameters could be used predict radiation pneumonitis of ≥Grade 2, the area under the curve (AUC) was determined from the receiver operating characteristic analysis. Results For Mean Dose, poorly ventilated lung regions in the 0±30% range showed the highest AUC value (0.809; 95% confidence interval [CI], 0.663±0.955). For V20, poorly ventilated lung regions in the 0±20% range had the highest AUC value (0.774; 95% [CI], 0.598±0.915), and for V5, poorly ventilated lung regions in the 0±30% range had the highest AUC value (0.843; 95% [CI], 0.732±0.954). The highest AUC values for Mean Dose, V20, and V5 were obtained in poorly ventilated regions. There were significant differences in all dosimetric parameters between radiation pneumonitis of Grade 1 and Grade ≥2. Conclusions Poorly ventilated lung regions identified on 4D-CT had higher AUC values than highly ventilated regions, suggesting that functional planning based on poorly ventilated regions may reduce the risk of lung toxicity in radiation therapy.

ジャーナルPloS one
出版ステータスPublished - 2018 10

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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