Abstract
Lung cancer is a leading cause of death worldwide. Radiation therapy (RT) is one method to treat this disease. A common side effect of RT for lung cancer is radiation-induced lung damage (RILD) which leads to loss of lung function. RILD often compounds pre-existing smoking-related regional lung function impairment. It is difficult to predict patient outcomes due to large variability in individual response to RT. In this study, the capability of image-based modelling of regional ventilation in lung cancer patients to predict lung function post-RT was investigated. Twenty-five patient-based models were created using CT images to define the airway geometry, size and location of tumour, and distribution of emphysema. Simulated ventilation within the 20 Gy isodose volume showed a statistically significant negative correlation with the change in forced expiratory volume in 1 s 12-months post-RT (p = 0.001, R = − 0.61). Patients with higher simulated ventilation within the 20 Gy isodose volume had a greater loss in lung function post-RT and vice versa. This relationship was only evident with the combined impact of tumour and emphysema, with the location of the emphysema relative to the dose-volume being important. Our results suggest that model-based ventilation measures can be used in the prediction of patient lung function post-RT.
Highlights
Lung cancer is the most commonly diagnosed cancer and is the leading cause of cancer death worldwide.[5]
The mean normalised ventilation distribution was similar across all subject models before disease effects being added, there was some variation across the subjects due to differences in the airway network geometry, lung sizes, and the initial volume of acini within the patient-based models
The addition of the tumour effects showed a modest impact on the ventilation distribution with the largest change being observed when emphysema was added alongside the tumour effects
Summary
Lung cancer is the most commonly diagnosed cancer and is the leading cause of cancer death worldwide.[5] Radiation therapy (RT) is an important component of the cure or palliation of patients with lung cancer. In some cases, lung function is preserved or can even improve postRT.[18] This could be due to the reduction or removal of a tumour that was previously obstructing major airways. Another hypothesis is that RT can reduce hyperinflation of pathological tissue within the dosevolume in patients with emphysema, improving elastic recoil and function in the surrounding tissue.[3] It
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