Clinical research on combination of dose-volume histogram parameters with pulmonary perfusion imaging to predict the radiation pneumonitis / 肿瘤研究与临床

ABSTRACT

Objective To evaluate the lung exposure dose-volume (DVH) parameters and other indicators of lung perfusion imaging before and after three-dimensional conformal or intensity modulated radiation therapy for lung cancer patients,and combined with clinical factors,to explore relationship with radiation pneumonitis occurred.Methods 18 patients were selected for data analysis.Lung perfusion scintigraphy was detected before and after three-dimensional conformal or intensity modulated radiation therapy for lung cancer.Lung perfusion changes were compared before and after irradiation.Evaluation of radiation pneumonitis was assessed by the Radiation Therapy Oncology Group (RTOG) acute radiation pneumonitis standard.After the CT and SPECT lung perfusion images were transferred to Varian,the Eclipse 3D treatment planning system,image fusion after dose curve projected onto the SPECT images,and the DVH was converted into a f-DVH diagram.Analysis of pulmonary perfusion imaging changes before and after radiotherapy combined with lung irradiation dose volume parameters and radiation pneumonitis.Results In the whole group,33.3 ％ (6/18) cases occurred more than 2 radiation pneumonitis.Before and after radiotherapy,the damage to the lung perfusion was more than 2 radiation pneumonitis incidence [62.5 ％ (5/8)],and impaired pulmonary perfusion improvement was 10.0 ％ (1/10).DVH parameters to V5 severe RP forecasted high accuracy.In curve for each patient,boundary values of V5,V10 and V20 were 53 ％,41％ and 27 ％.Before and after radiotherapy it was found that lung perfusion changes and the whole lung V5 portfolio were the strongest predictors for radiation pneumonitis after radiotherapy.Conclusion Pulmonary perfusion imaging in patients with lung cancer is able to reflect changes in the function of ipsilateral lung perfusion before and after radiotherapy.Changes in the ipsilateral lung perfusion detected before and after radiotherapy combined with V5 are expected to serve as indicators to predict radiation pneumonitis.