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Comparison of Regional Lung Perfusion Response On Longitudinal MAA SPECT/CT in Lung Cancer Patients Treated with and Without Functional Lung Avoidance Radiation Therapy

H Thomas 1*, J Zeng1 , H Lee2 , B Sasidharan3 , P Kinahan1 , R Miyaoka1 , H Vesselle1 , R Rengan1 , S Bowen1 , (1) University of Washington School of Medicine, Seattle, WA, (2) Duke University, Durham, North Carolina, (3) Christian Medical College Vellore, Vellore, Tamil Nadu


(Wednesday, 8/1/2018) 7:30 AM - 9:30 AM

Room: Karl Dean Ballroom C

Purpose: The effect of functional lung avoidance planning on radiation dose-dependent changes in regional lung perfusion is unknown. We characterized patient-specific dose-response on longitudinal perfusion SPECT/CT in two cohorts of lung cancer patients treated with and without functional lung avoidance techniques.

Methods: MAA-SPECT/CT treatment position scans at baseline and three months post-treatment were acquired in 14 stage IIB-IIIB NSCLC patients from an interventional study (FLARE-RT) and 8 lung cancer patients from an observational study (LUNG-RT). Incidence of baseline COPD trended lower in FLARE-RT patients (3/14 [21%]) compared to LUNG-RT patients (5/8 [63%], Fisher’s Exact p=0.08). FLARE-RT plans included perfused lung dose constraints while LUNG-RT plans adhered to clinical standards. Pre/post-treatment SPECT/CT scans were rigidly co-registered to planning 4DCT scans. Tumor-subtracted lung dose was converted to EQD2 and discretized into 5 GyEQD2 increments. Mean dose and percent change between pre- and post-RT MAA-SPECT uptake (%ΔPERF), normalized to total tumor-subtracted lung uptake, were calculated in each binned dose region. Dose-response data were parameterized by sigmoid logistic functions to estimate minimum reduction (%ΔPERF���), maximum reduction (%ΔPERF�ᵃˣ), dose midpoint (D��ᵈ), and dose-response slope (b).

Results: Dose-response goodness-of-fit was higher in FLARE-RT (R²=0.97) compared to LUNG-RT (R²=0.84). FLARE-RT response was characterized by >10% increase in perfusion at low doses for 5/14 patients (|%ΔPERF���|=16-42%), which was not observed in any LUNG-RT patients. Median D��ᵈ trended higher for FLARE-RT compared to LUNG-RT (28 GyEQD2 vs. 21 GyEQD2, Mann-Whitney p=0.09). Slope b had narrower inter-patient range in FLARE-RT (0-7.1) than LUNG-RT (1.0-15.8), while %ΔPERF�ᵃˣ had broader range in FLARE-RT (3-136%) than LUNG-RT (1-110%).

Conclusion: Functional lung avoidance planning may promote increased post-treatment perfusion in low-dose regions for select patients, though inter-patient variability in dose-response parameters remains high. Individualized estimation of regional lung perfusion response can further refine risk-adaptive strategies to minimize lung function deficits and toxicity incidence.

Funding Support, Disclosures, and Conflict of Interest: This work was supported by NIH/NCI R01CA204301.


Perfusion Imaging, SPECT, Lung


IM- SPECT : Quantitative imaging/analysis

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