Quantification of Tumor Volume Changes During Radiotherapy for Non–Small-Cell Lung Cancer
Purpose Dose escalation for lung cancer is limited by normal tissue toxicity. We evaluated sequential computed tomography (CT) scans to assess the possibility of adaptively reducing treatment volumes by quantifying the tumor volume reduction occurring during a course of radiotherapy (RT). Methods an...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2009-06, Vol.74 (2), p.341-348 |
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| creator | Fox, Jana, M.D Ford, Eric, Ph.D Redmond, Kristin, M.D Zhou, Jessica, B.S Wong, John, Ph.D Song, Danny Y., M.D |
| description | Purpose Dose escalation for lung cancer is limited by normal tissue toxicity. We evaluated sequential computed tomography (CT) scans to assess the possibility of adaptively reducing treatment volumes by quantifying the tumor volume reduction occurring during a course of radiotherapy (RT). Methods and Materials A total of 22 patients underwent RT for Stage I-III non–small-cell lung cancer with conventional fractionation; 15 received concurrent chemotherapy. Two repeat CT scans were performed at a nominal dose of 30 Gy and 50 Gy. Respiration-correlated four-dimensional CT scans were used for evaluation of respiratory effects in 17 patients. The gross tumor volume (GTV) was delineated on simulation and all individual phases of the repeat CT scans. Parenchymal tumor was evaluated unless the nodal volume was larger or was the primary. Subsequent image sets were spatially co-registered with the simulation data for evaluation. Results The median GTV reduction was 24.7% (range, −0.3% to 61.7%; p < 0.001, two-tailed t test) at the first repeat scan and 44.3% (range, 0.2–81.6%, p < 0.001) at the second repeat scan. The volume reduction was not significantly different between patients receiving chemoradiotherapy vs. RT alone, a GTV >100 cm3 vs. |
| doi_str_mv | 10.1016/j.ijrobp.2008.07.063 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_osti_</sourceid><recordid>TN_cdi_osti_scitechconnect_21276805</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0360301608033518</els_id><sourcerecordid>20678809</sourcerecordid><originalsourceid>FETCH-LOGICAL-c540t-d5aa6fd890f6ae58becba3c57a927dfbb55a49f66815cffee7f139da72bcd21d3</originalsourceid><addsrcrecordid>eNqFkc2q1TAUhYso3uPVNxApCM5ad5qmTSeC1F84KHqvIjgIabpzT2qbHJNWODPfwTf0SUzpAcGJo0y-vbL4VpI8JJATINXTITeDd90xLwB4DnUOFb2V7Aivm4wy9uV2sgNaQUYjfJHcC2EAAELq8m5yQRqgnEG5S75-WKSdjTZKzsbZ1On0epmcTz-7cZkwbQ_S3mBIXyze2Jv0o-yNmw_o5fGU6oi9c_b3z19XkxzHrMVxTPdLxFppFfr7yR0tx4APzu9l8unVy-v2TbZ___pt-3yfKVbCnPVMykr3vAFdSWS8Q9VJqlgtm6LuddcxJstGVxUnTGmNWGtCm17WRaf6gvT0Mnm85bowGxGUmVEdlLMW1SwKUtQVBxapJxt19O77gmEWkwkqVpYW3RJEAVXNOTQRLDdQeReCRy2O3kzSnwQBsaoXg9jUi1W9gFpE9fHs0Tl_6Sbs_x6dXUfg2QZgdPHDoF-rYhTVG7827Z353w__BqjR2Ljc-A1PGAa3eBs9CyJCIUBcrfOv6wMHShnh9A_hCq28</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>20678809</pqid></control><display><type>article</type><title>Quantification of Tumor Volume Changes During Radiotherapy for Non–Small-Cell Lung Cancer</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Fox, Jana, M.D ; Ford, Eric, Ph.D ; Redmond, Kristin, M.D ; Zhou, Jessica, B.S ; Wong, John, Ph.D ; Song, Danny Y., M.D</creator><creatorcontrib>Fox, Jana, M.D ; Ford, Eric, Ph.D ; Redmond, Kristin, M.D ; Zhou, Jessica, B.S ; Wong, John, Ph.D ; Song, Danny Y., M.D</creatorcontrib><description>Purpose Dose escalation for lung cancer is limited by normal tissue toxicity. We evaluated sequential computed tomography (CT) scans to assess the possibility of adaptively reducing treatment volumes by quantifying the tumor volume reduction occurring during a course of radiotherapy (RT). Methods and Materials A total of 22 patients underwent RT for Stage I-III non–small-cell lung cancer with conventional fractionation; 15 received concurrent chemotherapy. Two repeat CT scans were performed at a nominal dose of 30 Gy and 50 Gy. Respiration-correlated four-dimensional CT scans were used for evaluation of respiratory effects in 17 patients. The gross tumor volume (GTV) was delineated on simulation and all individual phases of the repeat CT scans. Parenchymal tumor was evaluated unless the nodal volume was larger or was the primary. Subsequent image sets were spatially co-registered with the simulation data for evaluation. Results The median GTV reduction was 24.7% (range, −0.3% to 61.7%; p < 0.001, two-tailed t test) at the first repeat scan and 44.3% (range, 0.2–81.6%, p < 0.001) at the second repeat scan. The volume reduction was not significantly different between patients receiving chemoradiotherapy vs. RT alone, a GTV >100 cm3 vs. <100 cm3 , and hilar and/or mediastinal involvement vs. purely parenchymal or pleural lesions. A tendency toward a greater volume reduction with increasing dose was seen, although this did not reach statistical significance. Conclusion The results of this study have demonstrated significant alterations in the GTV seen on repeat CT scans during RT. These observations raise the possibility of using an adaptive approach toward RT of non–small-cell lung cancer to minimize the dose to normal structures and more safely increase the dose directed at the target tissues.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2008.07.063</identifier><identifier>PMID: 19038504</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adaptive radiotherapy ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Carcinoma, Non-Small-Cell Lung - diagnostic imaging ; Carcinoma, Non-Small-Cell Lung - drug therapy ; Carcinoma, Non-Small-Cell Lung - pathology ; Carcinoma, Non-Small-Cell Lung - radiotherapy ; CAT SCANNING ; CHEMOTHERAPY ; Combined Modality Therapy - methods ; COMBINED THERAPY ; EVALUATION ; Hematology, Oncology and Palliative Medicine ; Humans ; Lung Neoplasms - diagnostic imaging ; Lung Neoplasms - drug therapy ; Lung Neoplasms - pathology ; Lung Neoplasms - radiotherapy ; LUNGS ; NEOPLASMS ; Non–small-cell lung cancer ; PATIENTS ; RADIATION DOSES ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; Radiotherapy Dosage ; SIMULATION ; Tomography, X-Ray Computed ; TOXICITY ; Tumor Burden - radiation effects ; Volume changes</subject><ispartof>International journal of radiation oncology, biology, physics, 2009-06, Vol.74 (2), p.341-348</ispartof><rights>Elsevier Inc.</rights><rights>2009 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c540t-d5aa6fd890f6ae58becba3c57a927dfbb55a49f66815cffee7f139da72bcd21d3</citedby><cites>FETCH-LOGICAL-c540t-d5aa6fd890f6ae58becba3c57a927dfbb55a49f66815cffee7f139da72bcd21d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2008.07.063$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19038504$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/21276805$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Fox, Jana, M.D</creatorcontrib><creatorcontrib>Ford, Eric, Ph.D</creatorcontrib><creatorcontrib>Redmond, Kristin, M.D</creatorcontrib><creatorcontrib>Zhou, Jessica, B.S</creatorcontrib><creatorcontrib>Wong, John, Ph.D</creatorcontrib><creatorcontrib>Song, Danny Y., M.D</creatorcontrib><title>Quantification of Tumor Volume Changes During Radiotherapy for Non–Small-Cell Lung Cancer</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose Dose escalation for lung cancer is limited by normal tissue toxicity. We evaluated sequential computed tomography (CT) scans to assess the possibility of adaptively reducing treatment volumes by quantifying the tumor volume reduction occurring during a course of radiotherapy (RT). Methods and Materials A total of 22 patients underwent RT for Stage I-III non–small-cell lung cancer with conventional fractionation; 15 received concurrent chemotherapy. Two repeat CT scans were performed at a nominal dose of 30 Gy and 50 Gy. Respiration-correlated four-dimensional CT scans were used for evaluation of respiratory effects in 17 patients. The gross tumor volume (GTV) was delineated on simulation and all individual phases of the repeat CT scans. Parenchymal tumor was evaluated unless the nodal volume was larger or was the primary. Subsequent image sets were spatially co-registered with the simulation data for evaluation. Results The median GTV reduction was 24.7% (range, −0.3% to 61.7%; p < 0.001, two-tailed t test) at the first repeat scan and 44.3% (range, 0.2–81.6%, p < 0.001) at the second repeat scan. The volume reduction was not significantly different between patients receiving chemoradiotherapy vs. RT alone, a GTV >100 cm3 vs. <100 cm3 , and hilar and/or mediastinal involvement vs. purely parenchymal or pleural lesions. A tendency toward a greater volume reduction with increasing dose was seen, although this did not reach statistical significance. Conclusion The results of this study have demonstrated significant alterations in the GTV seen on repeat CT scans during RT. These observations raise the possibility of using an adaptive approach toward RT of non–small-cell lung cancer to minimize the dose to normal structures and more safely increase the dose directed at the target tissues.</description><subject>Adaptive radiotherapy</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Carcinoma, Non-Small-Cell Lung - diagnostic imaging</subject><subject>Carcinoma, Non-Small-Cell Lung - drug therapy</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>Carcinoma, Non-Small-Cell Lung - radiotherapy</subject><subject>CAT SCANNING</subject><subject>CHEMOTHERAPY</subject><subject>Combined Modality Therapy - methods</subject><subject>COMBINED THERAPY</subject><subject>EVALUATION</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Lung Neoplasms - diagnostic imaging</subject><subject>Lung Neoplasms - drug therapy</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - radiotherapy</subject><subject>LUNGS</subject><subject>NEOPLASMS</subject><subject>Non–small-cell lung cancer</subject><subject>PATIENTS</subject><subject>RADIATION DOSES</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy Dosage</subject><subject>SIMULATION</subject><subject>Tomography, X-Ray Computed</subject><subject>TOXICITY</subject><subject>Tumor Burden - radiation effects</subject><subject>Volume changes</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc2q1TAUhYso3uPVNxApCM5ad5qmTSeC1F84KHqvIjgIabpzT2qbHJNWODPfwTf0SUzpAcGJo0y-vbL4VpI8JJATINXTITeDd90xLwB4DnUOFb2V7Aivm4wy9uV2sgNaQUYjfJHcC2EAAELq8m5yQRqgnEG5S75-WKSdjTZKzsbZ1On0epmcTz-7cZkwbQ_S3mBIXyze2Jv0o-yNmw_o5fGU6oi9c_b3z19XkxzHrMVxTPdLxFppFfr7yR0tx4APzu9l8unVy-v2TbZ___pt-3yfKVbCnPVMykr3vAFdSWS8Q9VJqlgtm6LuddcxJstGVxUnTGmNWGtCm17WRaf6gvT0Mnm85bowGxGUmVEdlLMW1SwKUtQVBxapJxt19O77gmEWkwkqVpYW3RJEAVXNOTQRLDdQeReCRy2O3kzSnwQBsaoXg9jUi1W9gFpE9fHs0Tl_6Sbs_x6dXUfg2QZgdPHDoF-rYhTVG7827Z353w__BqjR2Ljc-A1PGAa3eBs9CyJCIUBcrfOv6wMHShnh9A_hCq28</recordid><startdate>20090601</startdate><enddate>20090601</enddate><creator>Fox, Jana, M.D</creator><creator>Ford, Eric, Ph.D</creator><creator>Redmond, Kristin, M.D</creator><creator>Zhou, Jessica, B.S</creator><creator>Wong, John, Ph.D</creator><creator>Song, Danny Y., M.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope><scope>OTOTI</scope></search><sort><creationdate>20090601</creationdate><title>Quantification of Tumor Volume Changes During Radiotherapy for Non–Small-Cell Lung Cancer</title><author>Fox, Jana, M.D ; Ford, Eric, Ph.D ; Redmond, Kristin, M.D ; Zhou, Jessica, B.S ; Wong, John, Ph.D ; Song, Danny Y., M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c540t-d5aa6fd890f6ae58becba3c57a927dfbb55a49f66815cffee7f139da72bcd21d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adaptive radiotherapy</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Carcinoma, Non-Small-Cell Lung - diagnostic imaging</topic><topic>Carcinoma, Non-Small-Cell Lung - drug therapy</topic><topic>Carcinoma, Non-Small-Cell Lung - pathology</topic><topic>Carcinoma, Non-Small-Cell Lung - radiotherapy</topic><topic>CAT SCANNING</topic><topic>CHEMOTHERAPY</topic><topic>Combined Modality Therapy - methods</topic><topic>COMBINED THERAPY</topic><topic>EVALUATION</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Lung Neoplasms - diagnostic imaging</topic><topic>Lung Neoplasms - drug therapy</topic><topic>Lung Neoplasms - pathology</topic><topic>Lung Neoplasms - radiotherapy</topic><topic>LUNGS</topic><topic>NEOPLASMS</topic><topic>Non–small-cell lung cancer</topic><topic>PATIENTS</topic><topic>RADIATION DOSES</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy Dosage</topic><topic>SIMULATION</topic><topic>Tomography, X-Ray Computed</topic><topic>TOXICITY</topic><topic>Tumor Burden - radiation effects</topic><topic>Volume changes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fox, Jana, M.D</creatorcontrib><creatorcontrib>Ford, Eric, Ph.D</creatorcontrib><creatorcontrib>Redmond, Kristin, M.D</creatorcontrib><creatorcontrib>Zhou, Jessica, B.S</creatorcontrib><creatorcontrib>Wong, John, Ph.D</creatorcontrib><creatorcontrib>Song, Danny Y., M.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fox, Jana, M.D</au><au>Ford, Eric, Ph.D</au><au>Redmond, Kristin, M.D</au><au>Zhou, Jessica, B.S</au><au>Wong, John, Ph.D</au><au>Song, Danny Y., M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quantification of Tumor Volume Changes During Radiotherapy for Non–Small-Cell Lung Cancer</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2009-06-01</date><risdate>2009</risdate><volume>74</volume><issue>2</issue><spage>341</spage><epage>348</epage><pages>341-348</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose Dose escalation for lung cancer is limited by normal tissue toxicity. We evaluated sequential computed tomography (CT) scans to assess the possibility of adaptively reducing treatment volumes by quantifying the tumor volume reduction occurring during a course of radiotherapy (RT). Methods and Materials A total of 22 patients underwent RT for Stage I-III non–small-cell lung cancer with conventional fractionation; 15 received concurrent chemotherapy. Two repeat CT scans were performed at a nominal dose of 30 Gy and 50 Gy. Respiration-correlated four-dimensional CT scans were used for evaluation of respiratory effects in 17 patients. The gross tumor volume (GTV) was delineated on simulation and all individual phases of the repeat CT scans. Parenchymal tumor was evaluated unless the nodal volume was larger or was the primary. Subsequent image sets were spatially co-registered with the simulation data for evaluation. Results The median GTV reduction was 24.7% (range, −0.3% to 61.7%; p < 0.001, two-tailed t test) at the first repeat scan and 44.3% (range, 0.2–81.6%, p < 0.001) at the second repeat scan. The volume reduction was not significantly different between patients receiving chemoradiotherapy vs. RT alone, a GTV >100 cm3 vs. <100 cm3 , and hilar and/or mediastinal involvement vs. purely parenchymal or pleural lesions. A tendency toward a greater volume reduction with increasing dose was seen, although this did not reach statistical significance. Conclusion The results of this study have demonstrated significant alterations in the GTV seen on repeat CT scans during RT. These observations raise the possibility of using an adaptive approach toward RT of non–small-cell lung cancer to minimize the dose to normal structures and more safely increase the dose directed at the target tissues.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>19038504</pmid><doi>10.1016/j.ijrobp.2008.07.063</doi><tpages>8</tpages></addata></record> |
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| subjects | Adaptive radiotherapy Antineoplastic Combined Chemotherapy Protocols - therapeutic use Carcinoma, Non-Small-Cell Lung - diagnostic imaging Carcinoma, Non-Small-Cell Lung - drug therapy Carcinoma, Non-Small-Cell Lung - pathology Carcinoma, Non-Small-Cell Lung - radiotherapy CAT SCANNING CHEMOTHERAPY Combined Modality Therapy - methods COMBINED THERAPY EVALUATION Hematology, Oncology and Palliative Medicine Humans Lung Neoplasms - diagnostic imaging Lung Neoplasms - drug therapy Lung Neoplasms - pathology Lung Neoplasms - radiotherapy LUNGS NEOPLASMS Non–small-cell lung cancer PATIENTS RADIATION DOSES Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY Radiotherapy Dosage SIMULATION Tomography, X-Ray Computed TOXICITY Tumor Burden - radiation effects Volume changes |
| title | Quantification of Tumor Volume Changes During Radiotherapy for Non–Small-Cell Lung Cancer |
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