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Role of perfusion SPECT in prediction and measurement of pulmonary complications after radiotherapy for lung cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the study was to evaluate the ability of baseline perfusion defect score (DS) on SPECT to predict the development of severe symptomatic radiation pneumonitis (RP) and to evaluate changes in perfusion on SPECT as a method of lung perfusion function assessment after curative radiotherapy (RT) for non-small-cell lung cancer (NSCLC).

Methods

Patients with NSCLC undergoing curative RT were included prospectively. Perfusion SPECT/CT and global pulmonary function tests (PFT) were performed before RT and four times during follow-up. Functional activity on SPECT was measured using a semiquantitative perfusion DS. Pulmonary morbidity was graded by the National Cancer Institute’s Common Terminology Criteria for Adverse Events version 4 for pneumonitis. Patients were divided into two groups according to the severity of RP.

Results

A total of 71 consecutive patients were included in the study. Baseline DS was associated with chronic obstructive pulmonary disease. A significant inverse correlation was found between baseline DS and forced expiratory volume in 1 s and diffusing capacity of the lung for carbon monoxide. Patients with severe RP had significantly higher baseline total lung DS (mean 5.43) than those with no or mild symptoms (mean DS 3.96, p < 0.01). PFT results were not different between these two groups. The odds ratio for total lung DS was 7.8 (95 % CI 1.9 – 31) demonstrating the ability of this parameter to predict severe RP. Adjustment for other potential confounders known to be associated with increased risk of RP was performed and did not change the odds ratio. The median follow-up time after RT was 8.4 months. The largest DS increase of 13.3 % was associated with severe RP at 3 months of follow-up (p < 0.01). The development of severe RP during follow-up was not associated with changes in PFT results.

Conclusion

Perfusion SPECT is a valuable method for predicting severe RP and for assessing changes in regional functional perfusion after curative RT comparable with global PFT.

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Compliance with ethical standards

Conflicts of interest

None.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not describe any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Acknowledgments

The authors thank Henrik Bluhme for technical assistance in editing the SPECT/CT images and Peter Iversen for scoring the SPECT/CT images for interobserver analysis. The authors acknowledge Michael Væth, Department of Biostatistics, Aarhus University, for helpful advice on statistical analysis. The authors appreciate the advice of Ditte Møller, Department of Medical Physics, Aarhus University Hospital, concerning dosimetric calculations. The authors thank Mai-Britt Ellegaard for her skilful assistance in patient recruitment and follow-up.

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Authors and Affiliations

  1. Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, build 5, 2, DK-8000, Aarhus C, Denmark

    Katherina P. Farr, Azza A. Khalil & Cai Grau

  2. Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Noerrebrogade 44, DK-8000, Aarhus C, Denmark

    Stine Kramer & Anni Morsing

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  1. Katherina P. Farr
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Correspondence to Katherina P. Farr.

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Farr, K.P., Kramer, S., Khalil, A.A. et al. Role of perfusion SPECT in prediction and measurement of pulmonary complications after radiotherapy for lung cancer. Eur J Nucl Med Mol Imaging 42, 1315–1324 (2015). https://doi.org/10.1007/s00259-015-3052-3

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  • DOI: https://doi.org/10.1007/s00259-015-3052-3

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