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Perfusion SPECT guided dose escalation in radiation therapy for lung cancer patients Yin, Lingshu
Abstract
Radiation therapy (RT) is a standard of care for patients with locally advanced inoperable non-small cell lung cancer (NSCLC). Prognosis for these patients is poor with 2-years survival below 20%. A substantial proportion of the lung cancer patients receiving RT develop symptomatic radiation pneumonitis (RP) as radiationinduced side effects. Thus, sparing of normal lung is one of the important goals for lung cancer patients receiving RT. Currently in clinical practice, the sparing of lung is assessed based on the dosevolume histogram (DVH) assuming homogeneous lung function which is clearly not valid. Lung perfusion scan using Single Photon Emission Computed Tomography (SPECT) with ⁹⁹mTc macroaggregated albumin (⁹⁹mTc-MAA) provides unique functional information (lung perfusion i.e. blood flow) about the lung and holds the potential to improve normal tissue sparing in RT. Incorporating functional information from perfusion SPECT scan into RT treatment planning allows for identifying and sparing the well perfused parts of lung, thus reducing the risk of clinically significant radiation-induced lung complications. From February 2008 to May 2011, 22 lung cancer patients in BC Cancer Agency were recruited into this ethics board approved SPECT study. The goal of this study is to establish a framework for SPECT-guided RT treatment planning and dose escalation trials. In this study, the incorporation of SPECT into RT treatment planning is carried out in a sequential manner including: 1. Reconstruction of SPECT images and investigating the metric of functional sparing for treatment planning 2. Evaluation of SPECT image registration algorithms 3. Developing the methodology of SPECT-guided intensity modulated radiation therapy (IMRT) treatment planning with a Monte Carlo based beamlets dose calculation 4. Evaluation of the effectiveness of SPECT-guided RT through a planning study comparing DVH and SPECT-driven IMRT plans. In conclusion, comparing to conventional DVH driven IMRT plans, we found that SPECT-driven IMRT plans provide better sparing of both lung function and volume. Mean lung dose and SPECT-weighted mean dose can be reduced by 10.8% and 13.1%, respectively. We suggest that the use of SPECT guided IMRT treatment planning improves the sparing of lung functionality and makes possible dose escalations in patients with non-small cell lung cancers.
Item Metadata
Title |
Perfusion SPECT guided dose escalation in radiation therapy for lung cancer patients
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Creator | |
Publisher |
University of British Columbia
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Date Issued |
2012
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Description |
Radiation therapy (RT) is a standard of care for patients with locally advanced inoperable
non-small cell lung cancer (NSCLC). Prognosis for these patients is poor
with 2-years survival below 20%. A substantial proportion of the lung cancer patients
receiving RT develop symptomatic radiation pneumonitis (RP) as radiationinduced
side effects. Thus, sparing of normal lung is one of the important goals for
lung cancer patients receiving RT.
Currently in clinical practice, the sparing of lung is assessed based on the dosevolume
histogram (DVH) assuming homogeneous lung function which is clearly
not valid. Lung perfusion scan using Single Photon Emission Computed Tomography
(SPECT) with ⁹⁹mTc macroaggregated albumin (⁹⁹mTc-MAA) provides unique
functional information (lung perfusion i.e. blood flow) about the lung and holds the
potential to improve normal tissue sparing in RT. Incorporating functional information
from perfusion SPECT scan into RT treatment planning allows for identifying
and sparing the well perfused parts of lung, thus reducing the risk of clinically
significant radiation-induced lung complications.
From February 2008 to May 2011, 22 lung cancer patients in BC Cancer
Agency were recruited into this ethics board approved SPECT study. The goal
of this study is to establish a framework for SPECT-guided RT treatment planning
and dose escalation trials. In this study, the incorporation of SPECT into RT
treatment planning is carried out in a sequential manner including:
1. Reconstruction of SPECT images and investigating the metric of functional
sparing for treatment planning
2. Evaluation of SPECT image registration algorithms 3. Developing the methodology of SPECT-guided intensity modulated radiation
therapy (IMRT) treatment planning with a Monte Carlo based beamlets
dose calculation
4. Evaluation of the effectiveness of SPECT-guided RT through a planning
study comparing DVH and SPECT-driven IMRT plans.
In conclusion, comparing to conventional DVH driven IMRT plans, we found
that SPECT-driven IMRT plans provide better sparing of both lung function and
volume. Mean lung dose and SPECT-weighted mean dose can be reduced by
10.8% and 13.1%, respectively. We suggest that the use of SPECT guided IMRT
treatment planning improves the sparing of lung functionality and makes possible
dose escalations in patients with non-small cell lung cancers.
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Genre | |
Type | |
Language |
eng
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Date Available |
2012-04-02
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Provider |
Vancouver : University of British Columbia Library
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Rights |
Attribution-NonCommercial-NoDerivatives 4.0 International
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DOI |
10.14288/1.0072651
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URI | |
Degree | |
Program | |
Affiliation | |
Degree Grantor |
University of British Columbia
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Graduation Date |
2012-05
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Campus | |
Scholarly Level |
Graduate
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Rights URI | |
Aggregated Source Repository |
DSpace
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Rights
Attribution-NonCommercial-NoDerivatives 4.0 International