2022 World Conference on Lung Cancer (ePosters)-EP05.01-019. 4D CT Ventilation Image-Guided Lung Functional Avoidance Radiotherapy: A Single-Arm Prospective Pilot Clinical Trial

EP05.01-019. 4D CT Ventilation Image-Guided Lung Functional Avoidance Radiotherapy: A Single-Arm Prospective Pilot Clinical Trial

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This document presents the findings of a single-arm prospective pilot clinical trial that aimed to assess the safety and feasibility of functional avoidance radiotherapy (RT) using 4D CT ventilation imaging in patients with lung cancer. The study aimed to reduce pulmonary toxicity associated with thoracic RT by preferentially avoiding irradiating normal lung regions. <br /><br />The study enrolled 34 patients with non-small cell lung cancer, who received either conventionally fractionated RT (CFRT) or stereotactic body RT (SBRT). Standard-of-care 4D CT scans were used to generate ventilation images, and each patient required a standard intensity-modulated RT (IMRT) plan and a ventilation image-guided functional avoidance IMRT plan. The primary outcome measure was the rate of grade 3 adverse events (AEs).<br /><br />The results showed that functional avoidance RT significantly reduced dose to ventilated lung regions without compromising target coverage or adherence to standard organs at risk constraints. The median reduction in lung function receiving 20 Gy was 3.4% for CFRT and 1.3% for SBRT. The study demonstrated the safety and feasibility of functional avoidance RT with 4D CT ventilation imaging, which only requires a standard-of-care 4D CT scan and image processing/analysis.<br /><br />The rates of grade 3 pneumonitis and esophagitis were within the predetermined safety thresholds for CFRT, and no patients developed grade 3 AEs for SBRT. The study represents one of the first prospective investigations on lung functional avoidance RT.<br /><br />Overall, the findings of this pilot clinical trial suggest that functional avoidance RT with 4D CT ventilation imaging can effectively reduce pulmonary toxicity in patients undergoing thoracic RT for lung cancer. This method has advantages such as higher spatial resolution, lower cost, and greater availability compared to other imaging techniques. Further research and larger trials are needed to validate these results and establish functional avoidance RT as a standard treatment option in clinical practice.

Asset Subtitle

Megan Eileen Daly

Meta Tag

Speaker Megan Eileen Daly

Topic Locally Advanced Non-small Cell Lung Cancer - Chemoradiotherapy and Radiotherapy

Keywords

functional avoidance radiotherapy

4D CT ventilation imaging

lung cancer

pulmonary toxicity

thoracic RT

non-small cell lung cancer

conventionally fractionated RT

stereotactic body RT

intensity-modulated RT

adverse events