Quantification of Tumor Volume Changes During Radiotherapy for Non-Small-Cell Lung Cancer

Jana L. Fox, Eric Ford, Kristin Redmond, Jessica Zhou, John Wong, Danny Y. Song

Research output: Contribution to journalArticle

79 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)341-348
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume74
Issue number2
DOIs
StatePublished - Jun 1 2009
Externally publishedYes

Fingerprint

Tumor Burden
Non-Small Cell Lung Carcinoma
lungs
radiation therapy
Radiotherapy
tumors
cancer
Tomography
tomography
dosage
Four-Dimensional Computed Tomography
Lung Neoplasms
Respiration
evaluation
Drug Therapy
respiration
data simulation
chemotherapy
fractionation
toxicity

Keywords

  • Adaptive radiotherapy
  • Non-small-cell lung cancer
  • Volume changes

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Quantification of Tumor Volume Changes During Radiotherapy for Non-Small-Cell Lung Cancer. / Fox, Jana L.; Ford, Eric; Redmond, Kristin; Zhou, Jessica; Wong, John; Song, Danny Y.

In: International Journal of Radiation Oncology Biology Physics, Vol. 74, No. 2, 01.06.2009, p. 341-348.

Research output: Contribution to journalArticle

Fox, Jana L. ; Ford, Eric ; Redmond, Kristin ; Zhou, Jessica ; Wong, John ; Song, Danny Y. / Quantification of Tumor Volume Changes During Radiotherapy for Non-Small-Cell Lung Cancer. In: International Journal of Radiation Oncology Biology Physics. 2009 ; Vol. 74, No. 2. pp. 341-348.
@article{d11a10cf333f4266abd636ccca89f872,
title = "Quantification of Tumor Volume Changes During Radiotherapy for Non-Small-Cell Lung Cancer",
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.",
keywords = "Adaptive radiotherapy, Non-small-cell lung cancer, Volume changes",
author = "Fox, {Jana L.} and Eric Ford and Kristin Redmond and Jessica Zhou and John Wong and Song, {Danny Y.}",
year = "2009",
month = "6",
day = "1",
doi = "10.1016/j.ijrobp.2008.07.063",
language = "English (US)",
volume = "74",
pages = "341--348",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Quantification of Tumor Volume Changes During Radiotherapy for Non-Small-Cell Lung Cancer

AU - Fox, Jana L.

AU - Ford, Eric

AU - Redmond, Kristin

AU - Zhou, Jessica

AU - Wong, John

AU - Song, Danny Y.

PY - 2009/6/1

Y1 - 2009/6/1

N2 - 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.

AB - 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.

KW - Adaptive radiotherapy

KW - Non-small-cell lung cancer

KW - Volume changes

UR - http://www.scopus.com/inward/record.url?scp=67349137431&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67349137431&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2008.07.063

DO - 10.1016/j.ijrobp.2008.07.063

M3 - Article

VL - 74

SP - 341

EP - 348

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 2

ER -