Correlation between the Changes in Lung Function and Lung Density Changes in Patients Following Radio- (Chemo-) Therapy for Thoracic Carcinomas — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Correlation between the Changes in Lung Function and Lung Density Changes in Patients Following Radio- (Chemo-) Therapy for Thoracic Carcinomas
Clinic for Radiation Oncology, Universitatsspital Zürich, Zürich, Switzerland
,
Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany
,
Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
,
Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
,
Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
1 Clinic for Radiation Oncology, Universitatsspital Zürich, Zürich, Switzerland
2 Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany
3 Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
4 Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
5 Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
Purpose: In this analysis we focused on the correlation of patients’ lung function (PFT) data and lung density changes (ΔHU) detected in follow - up CTs. Material and Methods: PFT and lung function data were available for 58 patients 12 weeks and 47 patients 6 months after radio- (chemo-) therapy for thoracic carcinomas (NSCLC, SCLC and esophageal carcinoma). The follow - up CT scans were matched with the planning CT scans of each patient and then subtracted to calculate ΔHU for each voxel using customized research software. PFT data regarding e.g. vital capacity (VC), total lung capacity (TLC) and diffusion capacity for carbon monoxide (DL CO ) were collected before and at several follow - up appointments after treatment. Results: 12 weeks after therapy there was a statistically significant correlation between difference in DL CO and the maximum ΔHU as well as the difference in TLC and the minimum ΔHU. 6 months after treatment there was a significant correlation between the difference in VC and DL CO with numerous lung density parameters, e.g. the mean and median lung density changes and the 75 th percentile of ΔHU. There was no significant correlation between the PFT parameters FEV1, pCO 2 and pO 2 and any lung density parameter at any follow - up appointment. Conclusion: There is a significant correlation between DL CO and ΔHU 6 months after treatment that most likely reflects the underlying pathological mechanisms in terms of the development of fibrotic lung tissue after RT. The relevance of the significant correlations 12 weeks after RT is questionable.
KeywordsLungThoracic NeoplasmsRadiation InjuriesPulmonary FibrosisLung Function
Krengli, M., Sacco, M., Loi, G., Masini, L., Ferrante, D., Gambaro, G., et al. (2008) Pulmonary Changes after Radiotherapy for Conservative Treatment of Breast Cancer: A Prospective Study. International Journal of Radiation Oncology, Biology, Physics, 70, 1460-1467. https://doi.org/10.1016/j.ijrobp.2007.08.050
Luis Lopez Guerra, J., Gomez, D., Zhuang, Y., Levy, L.B., Eapen, G., Liu, H., et al. (2012) Changes in Pulmonary Function after Three-Dimensional Conformal Radiotherapy, Intensity-Modulated Radiotherapy, or Proton Beam Therapy for Non-Small-Cell Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 83, e537-e543. https://doi.org/10.1016/j.ijrobp.2012.01.019
Borst, G.R., De Jaeger, K., Belderbos, J., Burgers, S.A. and Lebesque, J.V. (2005) Pulmonary Function Changes after Radiotherapy in Non–Small-Cell Lung Cancer Patients with Long-Term Disease-Free Survival. International Journal of Radiation Oncology, Biology, Physics, 62, 639-644. https://doi.org/10.1016/j.ijrobp.2004.11.029
De Jaeger, K., Seppenwoolde, Y., Boersma, L.J., Muller, S.H., Baas, P., Belderbos, J.S.A., et al. (2003) Pulmonary Function Following High-Dose Radiotherapy of Non-Small-Cell Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 55, 1331-1340. https://doi.org/10.1016/S0360-3016(02)04389-4
Abratt, R.P. and Willcox, P.A. (1995) The Effect of Irradiation on Lung Function and Perfusion in Patients with Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 31, 915-919. https://doi.org/10.1016/0360-3016(94)00513-3
Abratt, R.P. and Morgan, G.W. (2002) Lung Toxicity Following Chest Irradiation in Patients with Lung Cancer. Lung Cancer, 35, 103-109. https://doi.org/10.1016/S0169-5002(01)00334-8
Erven, K., Weltens, C., Nackaerts, K., Fieuws, S., Decramer, M. and Lievens, Y. (2012) Changes in Pulmonary Function Up to 10 Years after Locoregional Breast Irradiation. International Journal of Radiation Oncology, Biology, Physics, 82, 701-707. https://doi.org/10.1016/j.ijrobp.2010.12.058
Guckenberger, M., Klement, R.J., Kestin, L.L., Hope, A.J., Belderbos, J., Werner-Wasik, M., et al. (2013) Lack of a Dose-Effect Relationship for Pulmonary Function Changes after Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 85, 1074-1081. https://doi.org/10.1016/j.ijrobp.2012.09.016
Fan, M., Marks, L.B., Hollis, D., Bentel, G.G., Anscher, M.S., Sibley, G., et al. (2001) Can We Predict Radiation-Induced Changes in Pulmonary Function Based on the Sum of Predicted Regional Dysfunction? Journal of Clinical Oncology, 19, 543-550. https://doi.org/10.1200/JCO.2001.19.2.543
Mehta, V. (2005) Radiation Pneumonitis and Pulmonary Fibrosis in Non-Small-Cell Lung Cancer: Pulmonary Function, Prediction, and Prevention. International Journal of Radiation Oncology, Biology, Physics, 63, 5-24. https://doi.org/10.1016/j.ijrobp.2005.03.047
De Ruysscher, D., Sharifi, H., Defraene, G., Kerns, S.L., Christiaens, M., De Ruyck, K., et al. (2013) Quantification of Radiation-Induced Lung Damage with CT Scans: The Possible Benefit for Radiogenomics. Acta Oncologica, 52, 1405-1410. https://doi.org/10.3109/0284186X.2013.813074
Bernchou, U., Schytte, T., Bertelsen, A. and Bentzen, S.M. (2013) Time Evolution of Regional CT Density Changes in Normal Lung after IMRT for NSCLC. Radiotherapy and Oncology, 109, 89-94. https://doi.org/10.1016/j.radonc.2013.08.041
Phernambucq, E.C.J., Palma, D.A., Vincent, A., Smit, E.F. and Senan, S. (2011) Time and Dose-Related Changes in Radiological Lung Density after Concurrent Chemoradiotherapy for Lung Cancer. Lung Cancer, 74, 451-456. https://doi.org/10.1016/j.lungcan.2011.05.010
Palma, D.A., van Sornsen de Koste, J.R., Verbakel, W.F.A.R. and Senan, S. (2011) A New Approach to Quantifying Lung Damage after Stereotactic Body Radiation Therapy. Acta Oncologica, 50, 509-517. https://doi.org/10.3109/0284186X.2010.541934
Ma, J., Zhang, J., Zhou, S., Hubbs, J.L., Foltz, R.J., Hollis, D.R., et al. (2010) Regional Lung Density Changes after Radiation Therapy for Tumors in and Around Thorax. International Journal of Radiation Oncology, Biology, Physics, 76, 116-122. https://doi.org/10.1016/j.ijrobp.2009.01.025
Bertelsen, A., Schytte, T., Bentzen, S.M., Hansen, O., Nielsen, M. and Brink, C. (2011) Radiation Dose Response of Normal Lung Assessed by Cone Beam CT—A Potential Tool for Biologically Adaptive Radiation Therapy. Radiotherapy and Oncology, 100, 351-355. https://doi.org/10.1016/j.radonc.2011.08.012
Vagane, R., Danielsen, T., Fossa, S.D., Lokkevik, E. and Olsen, D.R. (2009) Late Regional Density Changes of the Lung after Radiotherapy for Breast Cancer. Radiotherapy and Oncology, 90, 148-152. https://doi.org/10.1016/j.radonc.2007.12.031
Seppenwoolde, Y., Muller, S.H., Theuws, J., Baas, P., Belderbos, J., Boersma, L.J., et al. (2000) Radiation Dose-Effect Relations and Local Recovery in Perfusion for Patients with Non–Small-Cell Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 47, 681-690. https://doi.org/10.1016/S0360-3016(00)00454-5
Wennberg, B., Gagliardi, G., Sundbom, L., Svane, G. and Lind, P. (2002) Early Response of Lung in Breast Cancer Irradiation: Radiologic Density Changes Measured by CT and Symptomatic Radiation Pneumonitis. International Journal of Radiation Oncology, Biology, Physics, 52, 1196-1206. https://doi.org/10.1016/S0360-3016(01)02770-5
Mazeron, R., Etienne-Mastroianni, B., Pérol, D., Arpin, D., Vincent, M., Falchero, L., et al. (2010) Predictive Factors of Late Radiation Fibrosis: A Prospective Study in Non-Small Cell Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 77, 38-43. https://doi.org/10.1016/j.ijrobp.2009.04.019
Kong, F.-M., Hayman, J.A., Griffith, K.A., Kalemkerian, G.P., Arenberg, D., Lyons, S., et al. (2006) Final Toxicity Results of a Radiation-Dose Escalation Study in Patients with Non–Small-Cell Lung Cancer (NSCLC): Predictors for Radiation Pneumonitis and Fibrosis. International Journal of Radiation Oncology, Biology, Physics, 65, 1075-1086. https://doi.org/10.1016/j.ijrobp.2006.01.051
Robnett, T.J., Machtay, M., Vines, E.F., McKenna, M.G., Algazy, K. and Gillies McKenna, W. (2000) Factors Predicting Severe Radiation Pneumonitis in Patients Receiving Definitive Chemoradiation for Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 48, 89-94. https://doi.org/10.1016/S0360-3016(00)00648-9
Leprieur, E.G., Fernandez, D., Chatellier, G., Klotz, S., Giraud, P. and Durdux, C. (2013) Acute Radiation Pneumonitis after Conformational Radiotherapy for Nonsmall Cell Lung Cancer: Clinical, Dosimetric, and Associated-Treatment Risk Factors. Journal of Cancer Research and Therapeutics, 9, 447-451. https://doi.org/10.4103/0973-1482.119339
Hernando, M.L., Marks, L.B., Bentel, G., Zhou, S.-M., Hollis, D., Das, S.K., et al. (2001) Radiation-Induced Pulmonary Toxicity: A Dose-Volume Histogram Analysis in 201 Patients with Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 51, 650-659. https://doi.org/10.1016/S0360-3016(01)01685-6
Luis Lopez Guerra, J., Gomez, D., Zhuang, Y., Levy, L.B., Eapen, G., Liu, H., et al. (2012) Change in Diffusing Capacity after Radiation as an Objective Measure for Grading Radiation Pneumonitis in Patients Treated for Non-Small-Cell Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 83, 1573-1579. https://doi.org/10.1016/j.ijrobp.2011.10.065
Schroder, C., Engenhart-Cabillic, R., Vorwerk, H., Schmidt, M., Huhnt, W., Blank, E., et al. (2017) Changes in Pulmonary Function and Influencing Factors after High-Dose Intrathoracic Radio(Chemo)Therapy. Strahlentherapie und Onkologie, 193, 125-131. https://doi.org/10.1007/s00066-016-1067-8
Jaen, J., Vazquez, G., Alonso, E., De Las Penas, M.D., Diaz, L., et al. (2012) Long-term Changes in Pulmonary Function after Incidental Lung Irradiation for Breast Cancer: A Prospective Study with 7-Year Follow-Up. International Journal of Radiation Oncology, Biology, Physics, 84, e565-e570. https://doi.org/10.1016/j.ijrobp.2012.07.003
Ma, J., Zhang, J., Zhou, S., Hubbs, J.L., Foltz, R.J., Hollis, D.R., et al. (2009) Association between RT-Induced Changes in Lung Tissue Density and Global Lung Function. International Journal of Radiation Oncology, Biology, Physics, 74, 781-789. https://doi.org/10.1016/j.ijrobp.2008.08.053
Lind, P.A., Svane, G., Gagliardi, G. and Svensson, C. (1999) Abnormalities by Pulmonary Regions Studied with Computer Tomography Following Local or Local-Regional Radiotherapy for Breast Cancer. International Journal of Radiation Oncology, Biology, Physics, 43, 489-496. https://doi.org/10.1016/S0360-3016(98)00414-3