Functional lung avoidance stereotactic body radiation therapy for central lung cancer patients
Year: 2025
Type: article
Abstract: Background: To improve patients’ quality of life, it is necessary to preserve the high-functioning regions of the lung. This study aimed to propose a planning strategy that prioritizes sparing ventilation function for stereotactic body radiation therapy (SBRT) in patients with central lung cancer. Methods: Twenty patients with central lung cancer were retrospectively enrolled. Ventilation maps were obtained from 4-dimensional computed tomography by deformable image registration and quantitative analysis. The top 60% and 30–60% of the total lung were defined as high- and medium-ventilation regions, respectively. Clinical plans and functional lung avoidance (FLA) plans were designed for each patient, and FLA plans were optimized to spare high-ventilation (H-V) regions. Dosimetric parameters were compared in terms of tumor coverage, plan heterogeneity, and dose of organs-at-risk (OARs). A patient-specific dose-function response model of Owen was applied to characterize personalized functional damage. Results: FLA plans led to significant reductions in the mean dose of H-V lung than in clinical plans (361.33 vs. 398.51 cGy, P<0.001), but at the expenses of degraded gradient index (4.95 vs. 4.58, P<0.001) and conformity index (0.82 vs. 0.86, P<0.05). Generalized estimated equations demonstrated the decreased risk of grade 2+ radiation pneumonitis (RP) by 1.51% (P<0.01), and grade 3+ by 0.39% (3.81% vs. 3.42%, P<0.01) for FLA plans. We also observed the average ventilation preservation for FLA as 0.17% (P=0.002) higher than clinical plans in one year after SBRT. Conclusions: FLA plans can preserve the post-radiotherapy lung function, limit the pulmonary toxicity, and further improve life quality for SBRT patients with central lung cancer.
Authors: Aihui Feng, Yanhua Duan, Yan Shao, Hao Wang, Hua Chen, Hengle Gu, Ying Huang, Zhenjiong Shen, Xufei Wang, Zhiyong Xu
Language: English
Subfield: Radiation
Field: Physics and Astronomy
Domain: Physical Sciences
Open Access status: diamond
OpenAlex ID: W4416613399