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Cone-beam CT-guided radiotherapy in the management of lung cancer

Diagnostic and therapeutic value

Cone-beam-CT-basierte Strahlentherapie bei Lungenkrebs

Diagnostischer und therapeutischer Wert

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Abstract

Background

Recent studies have demonstrated an increase in the necessity of adaptive planning over the course of lung cancer radiation therapy (RT) treatment. In this study, we evaluated intrathoracic changes detected by cone-beam CT (CBCT) in lung cancer patients during RT.

Methods and materials

A total of 71 lung cancer patients treated with fractionated CBCT-guided RT were evaluated. Intrathoracic changes and plan adaptation priority (AP) scores were compared between small cell lung cancer (SCLC, n = 13) and non-small cell lung cancer (NSCLC, n = 58) patients.

Results

The median cumulative radiation dose administered was 54 Gy (range 30–72 Gy) and the median fraction dose was 1.8 Gy (range 1.8–3.0 Gy). All patients were subjected to a CBCT scan at least weekly (range 1–5/week). We observed intrathoracic changes in 83 % of the patients over the course of RT [58 % (41/71) regression, 17 % (12/71) progression, 20 % (14/71) atelectasis, 25 % (18/71) pleural effusion, 13 % (9/71) infiltrative changes, and 10 % (7/71) anatomical shift]. Nearly half, 45 % (32/71), of the patients had one intrathoracic soft tissue change, 22.5 % (16/71) had two, and three or more changes were observed in 15.5 % (11/71) of the patients. Plan modifications were performed in 60 % (43/71) of the patients. Visual volume reduction did correlate with the number of CBCT scans acquired (r = 0.313, p = 0.046) and with the timing of chemotherapy administration (r = 0.385, p = 0.013).

Conclusion

Weekly CBCT monitoring provides an adaptation advantage in patients with lung cancer. In this study, the monitoring allowed for plan adaptations due to tumor volume changes and to other anatomical changes.

Zusammenfassung

Hintergrund

Neuere Studien haben eine zunehmende Notwendigkeit der adaptiven Bestrahlungsplanung im Verlauf der Bestrahlungsserie bei Patienten mit Lungenkrebs nachgewiesen. In der vorliegenden Studie haben wir intrathorakale Änderungen mittels Cone-beam-CT (CBCT) bei Lungenkrebspatienten während der Radiotherapie (RT) analysiert.

Methoden und Materialien

Analysiert wurden 71 Patienten, die eine fraktionierte CBCT-basierte RT bei Lungenkrebs erhalten haben. Intrathorakale Veränderungen und Priorität-Scores für die adaptive Plananpassung (AP) wurden zwischen kleinzelligem (SCLC: 13 Patienten) und nicht-kleinzelligem Bronchialkarzinom (NSCLC: 58 Patienten) verglichen.

Ergebnisse

Die mediane kumulative Strahlendosis betrug 54 Gy (Spanne 30–72 Gy), die mediane Einzeldosis 1,8 Gy (Spanne 1,8–3,0 Gy). Alle Patienten wurden mit einem CBCT-Scan mindestens einmal wöchentlich (Spanne 1–5/Woche) untersucht. Wir beobachteten intrathorakale Änderungen in 83% der Patienten im Verlauf der RT [58 % (41/71) Regression, 17 % (12/71) Progression, 20 % (14/71) Atelektase, 25 % (18/71) Pleuraerguss, 13 % (9/71) infiltrative Veränderungen und 10 % (7/71) anatomische Verschiebung des Tumors]. Fast die Hälfte der Patienten hatte eine intrathorakale Weichgewebeveränderung (45 %, 32/71) 22,5 % (16/71) hatten zwei. Drei oder mehr Veränderungen wurden in 15,5 % (11/71) der Patienten beobachtet. Planmodifikationen wurden in 60 % (43/71) der Patienten durchgeführt. Die visuelle Volumenreduktion korrelierte mit der Anzahl der erworbenen CBCT-Scans (r = 0,313; p = 0,046) als auch mit dem Zeitpunkt der Verabreichung der Chemotherapie (r = 0,385; p = 0,013).

Schlussfolgerung

Das wöchentliche CBCT-Monitoring bietet einen Adaptationsvorteil bei Patienten mit Lungenkrebs. In dieser Studie hat das Monitoring die adaptiven Plananpassungen auf Basis der Tumorvolumenveränderungen sowie der anderen intrathorakalen anatomischen Veränderungen ermöglicht.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany

    Khaled Elsayad M.D., Jan Kriz M.D., Gabriele Reinartz M.D., Sergiu Scobioala M.D., Iris Ernst M.D., Uwe Haverkamp Ph.D. &  Hans Theodor Eich M.D. Ph.D.

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  1. Khaled Elsayad M.D.
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  2. Jan Kriz M.D.
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  3. Gabriele Reinartz M.D.
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  4. Sergiu Scobioala M.D.
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  5. Iris Ernst M.D.
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  6. Uwe Haverkamp Ph.D.
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  7. Hans Theodor Eich M.D. Ph.D.
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Correspondence to Hans Theodor Eich M.D. Ph.D..

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Conflict of interest

K. Elsayad, J. Kriz, G. Reinartz, S. Scobioala, I. Ernst, U. Haverkamp, and H.T. Eich state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

Additional information

These data were presented in part at the Annual Meeting of the German Society for Radiation Oncology (DEGRO), June 25–28, 2015, Hamburg, Germany and were presented at the Annual Meeting of the American Society for Radiation Oncology (ASTRO), October 18–21, 2015, in San Antonio, TX, USA.

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Elsayad, K., Kriz, J., Reinartz, G. et al. Cone-beam CT-guided radiotherapy in the management of lung cancer. Strahlenther Onkol 192, 83–91 (2016). https://doi.org/10.1007/s00066-015-0927-y

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  • DOI: https://doi.org/10.1007/s00066-015-0927-y

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