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Pulmonary function changes following helical tomotherapy in patients with inoperable, locally advanced non-small cell lung cancer

Veränderungen der Lungenfunktion nach helikaler Tomotherapie bei Patienten mit lokal fortgeschrittenem nicht-kleinzelligem Lungenkarzinom

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To evaluate alterations in pulmonary function indices after helical tomotherapy and explore potential associations with biologically corrected dosimetric parameters.

Patients and methods

In 64 patients with inoperable locally advanced non-small cell lung cancer, pulmonary function tests before and within 6 months after radiotherapy were evaluated retrospectively. In the case of concurrent chemotherapy a total dose of 67.2 Gy was delivered, otherwise 70.5 Gy was provided. In 44 patients, late pulmonary function changes (≥6 months after radiotherapy) could also be assessed.


In the entire patient group, there were significant declines in forced expiratory volume in 1s (FEV1) (average change −4.1% predicted; P = 0.007), in forced vital capacity (FVC) (−4.9% predicted; P = 0.002), total lung capacity (TLC) (−5.8% predicted; P = 0.0016) and DLCO (diffusing capacity of the lung for carbon monoxide corrected for hemoglobin level) (−8.6% predicted; P < 0.001) during the first 6 months. Corresponding FEV1, FVC, TLC and DLCO declines in the subgroup with late measurements (after 11.3 months on average) were −5.7, −7.4, −7.0, −9.8% predicted. A multivariate analysis including V5Gy, V10Gy, V20Gy, V40Gy, V60Gy, mean lung dose (MLD), gross tumor volume (GTV) and planning target volume (PTV) as potential covariates showed that GTV was the most consistent contributor, being significant for ∆FEV1 (P = 0.003), ∆FVC (P = 0.003), ∆TLC (P = 0.001) and ∆DLCO (P = 0.01). V5Gy or V10Gy did not contribute to any of the lung function changes.


The decline in pulmonary function indices after helical tomotherapy was of similar magnitude to that observed in studies reporting the effect of conformal radiotherapy on lung function. Diffusion capacity was the parameter showing the largest decrease following radiation therapy as compared to baseline and correlated with gross tumor volume. None of the alterations in pulmonary function tests were associated with the lung volume receiving low-dose radiation.



Evaluation von Veränderungen von Lungenfunktionsparametern nach helikaler Tomotherapie und Untersuchung möglicher Zusammenhänge mit dosimetrischen Parametern nach strahlenbiologischer Korrektur.

Patienten und Methoden

Bei 64 Patienten mit inoperablem lokal fortgeschrittenem nicht-kleinzelligem Lungenkarzinom wurden vor der Strahlentherapie und innerhalb der ersten 6 Monate nach Behandlung Lungenfunktionsprüfungen durchgeführt und ausgewertet. Im Fall von konkomitant applizierter Chemotherapie wurde eine Gesamtdosis von 67,2 Gy vorgeschrieben, anderenfalls 70,5 Gy. Bei 44 der 64 Patienten konnten auch längerfristige funktionelle Veränderungen (≥6 Monate nach Strahlentherapie) ermittelt werden.


Im gesamten Patientenkollektiv wurden innerhalb der ersten 6 Monate signifikante Verminderungen der Einsekundenkapazität (FEV1) (durchschnittliche Änderung −4,1%/%Sollwert; P = 0,007), in forcierte Vitalkapazität (FVC) (−4,9%/%Sollwert; P = 0,002), totale Lungenkapazität (TLC) (−5,8%/%Sollwert; P = 0,0016) und DLCO (Diffusionskapazität) (−8,6%/%Sollwert; P < 0,001) gemessen. Die entsprechende Verminderung von FEV1, FVC, TLC und DLCO in der Gruppe mit späteren Messungen (im Durschnitt 11,3 Monate) waren −5,7, −7,4, −7,0, −9,8%/%Sollwert. Die Multivarianzanalyse unter Berücksichtigung von V5Gy, V10Gy, V20Gy, V40Gy, V60Gy, mittlere Lungendichte (MLD), makroskopische Tumorvolumen (GTV) und Planungszielvolumen (PTV) als mögliche Kovariablen zeigte, dass das GTV den stärksten Einfluss hatte. Auch ∆FEV1 (P = 0,003), ∆FVC (P = 0,003), ∆TLC (P = 0,001) und ∆DLCO (P = 0,01) erreichten Signifikanzniveau. V5Gy und V10Gy trugen nicht zur Verschlechterung der Lungenfunktion bei.


Nach helikaler Tomotherapie verschlechterten sich die Lungenfunktionsparameter in ähnlicher Weise wie in den Studien mit konformaler Strahlentherapie. Die Diffusionskapazität war der Parameter mit der größten Abnahme nach Tomotherapie und korrelierte mit dem Tumorvolumen (GTV). Keine der Veränderungen in der Lungenfunktionsprüfung war abhängig vom Lungenvolumen, das geringen Strahlendosen ausgesetzt war.

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We thank Daniel Schuermans for help with assembling the lung function data from this patient population.

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Correspondence to Dr. K. Vekens.

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Conflict of interest

K. Vekens, S. Verbanck, C. Collen, G. Storme, K. Barbé, M. De Ridder and E. Vanderhelst declare that they have no competing interests.

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Vekens, K., Verbanck, S., Collen, C. et al. Pulmonary function changes following helical tomotherapy in patients with inoperable, locally advanced non-small cell lung cancer. Strahlenther Onkol 196, 142–150 (2020). https://doi.org/10.1007/s00066-019-01489-8

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  • Pulmonary function indices
  • Radiation damage
  • Low-dose radiation
  • IMRT
  • Inoperable NSCLC


  • Lungenfunktionsparameter
  • Bestrahlungsschäden
  • Geringe Strahlendosen
  • Intensitätsmodulierte Strahlentherapie
  • Inoperables nicht-kleinzelliges Lungenkarzinom