Radiotherapy For Lung Cancer Research Articles

AI bias in lung cancer radiotherapy

Aim: In lung cancer research, AI has been trained to read chest radiographs, which has led to improved health outcomes. However, the use of AI in healthcare settings is not without its own set of drawbacks, with bias being primary among them. This study seeks to investigate AI bias in diagnosing and treating lung cancer patients. The research objectives of this study are threefold: 1) To determine which features of patient datasets are most susceptible to AI bias; 2) to then measure the extent of such bias; and 3) from the findings generated, offer recommendations for overcoming the pitfalls of AI in lung cancer therapy for the delivery of more accurate and equitable healthcare. Methods: We created a synthetic database consisting of 50 lung cancer patients using a large language model (LLM). We then used a logistic regression model to detect bias in AI-informed treatment plans. Results: The empirical results from our synthetic patient data illustrate AI bias along the lines of (1) patient demographics (specifically, age) and (2) disease classification/histology. As it concerns patient age, the model exhibited an accuracy rate of 82.7% for patients < 60 years compared to 85.7% for patients ≥ 60 years. Regarding disease type, the model was less adept in identifying treatment categories for adenocarcinoma (accuracy rate: 83.7%) than it was in predicting treatment categories for squamous cell carcinoma (accuracy rate: 92.3%). Conclusions: We address the implications of such results in terms of how they may exacerbate existing health disparities for certain patient populations. We conclude by outlining several strategies for addressing AI bias, including generating a more robust training dataset, developing software tools to detect bias, making the model’s code open access and soliciting user feedback, inviting oversight from an ethics review board, and augmenting patient datasets by synthesizing the underrepresented data.

Coronary artery calcium on lung cancer radiation planning CT aids cardiovascular risk assessment.

Patients with non-small cell lung cancer (NSCLC) undergoing thoracic radiation are at high cardiovascular risk. Semiquantitative assessment of coronary artery calcification (CAC) on baseline planning non-gated chest computed tomography (CT) scans may help further risk stratify patients. This study aimed to characterize the association between CAC and major adverse cardiovascular events (MACE; myocardial infarction or stroke) and assess the utility of semiquantitative assessment of CAC. Patients with NSCLC with non-contrast planning chest CT scans were evaluated for CAC. Planning scans were visually graded using the CAC-DRS method, stratifying patients into no, mild, moderate, and severe CAC groups. Demographics, comorbidities, and radiation treatment characteristics were gathered, and CAC groups were assessed for the incidence of MACE after initiation of radiation therapy. Out of 137 patients, 39 patients had no CAC, and 98 patients had any CAC (38 with mild CAC, 34 with moderate CAC, and 26 with severe CAC). There was 1 MACE event in the no CAC group and 11 in patients with any CAC. The presence of CAC was associated with increased MACE compared to no CAC (p = 0.034). Semiquantitative CAC analysis correlated with formal CAC scoring. There is a significantly lower incidence of MACE in patients with no CAC on planning CT compared to patients with higher burdens of CAC. CAC burden is an important risk factor for adverse cardiovascular events in patients with NSCLC undergoing thoracic radiation. Semiquantitative CAC scoring may be a useful proxy when formal CAC scoring is unavailable.

Cardiotoxicity following thoracic radiotherapy for lung cancer.

Radiotherapy is the standard of care treatment for unresectable NSCLC, combined with concurrent chemotherapy and adjuvant immunotherapy. Despite technological advances in radiotherapy planning and delivery, the risk of damage to surrounding thoracic tissues remains high. Cardiac problems, including arrhythmia, heart failure and ischaemic events, occur in 20% of patients with lung cancer who undergo radiotherapy. As survival rates improve incrementally for this cohort, minimising the cardiovascular morbidity of RT is increasingly important. Problematically, the reporting of cardiac endpoints has been poor in thoracic radiotherapy clinical trials, and retrospective studies have been limited by the lack of standardisation of nomenclature and endpoints. How baseline cardiovascular profile and cardiac substructure radiation dose distribution impact the risk of cardiotoxicity is incompletely understood. As Thoracic Oncology departments seek to expand the indications for radiotherapy, and as the patient cohort becomes older and more comorbid, there is a pressing need for cardiotoxicity to be comprehensively characterised with sophisticated oncology, physics and cardio-oncology evaluations. This review synthesises the evidence base for cardiotoxicity in conventional radiotherapy, focusing on lung cancer, including current data, unmet clinical needs, and future scientific directions.

Epoxymicheliolide Reduces Radiation-Induced Senescence and Extracellular Matrix Formation by Disrupting NF-κB and TGF-β/SMAD Pathways in Lung Cancer.

Lung cancer is a major cause of cancer-related mortality, and radiotherapy is often limited by tumor resistance and side effects. This study explores whether epoxymicheliolide (ECL), a compound from feverfew, can enhance radiotherapy efficacy in lung cancer. We tested ECL on A549 and PC-9 lung cancer cell lines to evaluate its effect on x-ray irradiation. We measured apoptosis, NF-κB pathway inhibition, TGF-β secretion reduction, and epithelial-mesenchymal transition suppression. Invivo, C57BL/6 mice with lung tumors received ECL and radiotherapy. ECL enhanced the antiproliferative effects of x-ray irradiation, induced apoptosis in senescent cells, inhibited the NF-κB pathway, reduced TGF-β levels, and suppressed epithelial-mesenchymal transition. ECL also inhibited tumor growth and improved survival in mice. ECL is a promising adjunct to radiotherapy for lung cancer, improving treatment outcomes by targeting multiple tumor progression mechanisms. It offers potential for enhanced management of lung cancer.

Knockdown of Inhibin Beta A Reversed the Epithelial Growth Factor Receptor Tyrosine Kinase Inhibitor Resistance and Enhanced the Therapeutic Effect of Radiotherapy in Non-Small Cell Lung Cancer.

Lung cancer is a malignant tumor with the highest mortality rate worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately half of all lung cancer cases. Inhibin beta A (INHBA) is a ligand of the transforming growth factor-beta superfamily. This study aimed to analyze the function of INHBA in NSCLC resistance cells. Gene Expression Omnibus and The Cancer Genome Atlas databases were used to identify differentially expressed genes (DEGs) in NSCLC resistance cells and patients. DEGs were further analyzed by gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis. A colony formation assay was performed to determine cell growth. Cell migration and invasion were tested by Transwell assay. Epithelial-mesenchymal transition (EMT)-related genes were analyzed using qRT-PCR and Western blot analysis. Using bioinformatics tools, INHBA was demonstrated to be overexpressed in NSCLC resistant cells and patients. Gefitinib treatment affected NSCLC resistant cells. Additionally, INHBA silencing or X-ray treatment suppressed the growth and metastasis of NSCLC resistant cells. Moreover, the combined application of INHBA silencing and X-ray treatment enhances the therapeutic effects. Moreover, EMT has been confirmed to occur in NSCLC resistant cell lines. Both INHBA silencing and X-ray treatment inhibited EMT development. This study demonstrated that INHBA silencing ameliorates EGFR-TKI resistance and enhances the therapeutic effect of radiotherapy in NSCLC.

A comparative dosimetric evaluation of dynamic conformal arc therapy and volumetric modulated arc therapy for lung stereotactic body radiotherapy

PurposeThis study assesses the viability of utilizing dynamic conformal arc therapy (DCAT) as an alternative to volumetric-modulated arc therapy (VMAT) in stereotactic body radiation therapy (SBRT) for lung cancer, with a focus on four-dimensional computed tomography (4DCT) in free-breathing conditions. Materials and methodsWe selected four non-small cell lung cancer (NSCLC) patients who had previously undergone VMAT SBRT and re-planned their treatment using DCAT. We compared the DCAT and VMAT plans based on dose distribution, conformity index (CI), homogeneity index (HI), gradient index (GI), and total monitor units (MUs). Quality assurance (QA) assessments for both plans were conducted using the Octavius 4D system (PTW, Freiburg, Germany). ResultsThe results showed that CIPaddick was 0.80 ± 0.06 and 0.79 ± 0.04 (p-value >0.05), HI was 1.16 ± 0.03 (p-value <0.05) and 1.07 ± 0.02, GI was 3.91 ± 0.05 and 3.40 ± 0.05 (p-value <0.05), and MU was 1880.42 ± 135.19 and 5020.82 ± 188.03 for DCAT and VMAT, respectively (p-value <0.05). The average gamma passing rate exceeded 95 % with a 2 %/2 mm criteria. The dose distribution displayed remarkable similarity between DCAT and VMAT. ConclusionThe DCAT technique exhibits the capacity to deliver PTV dose distributions comparable to those achieved with VMAT, while significantly reducing treatment duration.

Combination Immunotherapy With Radiotherapy in Non-Small Cell Lung Cancer: A Review of Evidence.

Radiotherapy plays a fundamental role in the treatment of patients with all stages of non-small-cell lung cancer (NSCLC). The emergence of immune checkpoint inhibitors (ICIs) has transformed the standard of care in these patients. The use of ICIs is increasingly utilized in the definitive setting as an adjunct to chemoradiotherapy or surgery and remains a vital component in the treatment of metastatic disease. Despite improvements in patient survival, the use of immunotherapy as monotherapy has shown limited overall response rates with susceptibility to resistance. Radiotherapy has been identified as a viable option to enhance the response rate to ICI and improve outcomes in NSCLC. We queried the English PubMed database utilizing variably combined search items including "radiation," "chemoradiation," "immune checkpoint," "immunotherapy," "stereotactic body radiotherapy," and "non-small-cell lung". We additionally searched various acceptable alternative terms for similar keywords such as "radiotherapy" in place of "radiation." These results were subsequently curated for relevance and impact on current treatment paradigms. In this review, we discuss preclinical and clinical studies relating to combinatorial use of immunotherapy and radiation in NSCLC. These studies are presented in the context of early-stage, operable stage III, unresectable stage III, and metastatic disease. The majority of the data illustrate promising results regarding the additive or synergistic effects of radiation and immunotherapy with a suggestion that the timing of these treatment modalities is crucial to optimizing outcomes. While there is now evidence regarding the favorable interplay between radiation and immunotherapy in NSCLC, there remain multiple unanswered questions which are expected to be addressed in ongoing clinical trials.

Local radiotherapy in extensive-stage small-cell lung cancer sustainably boosts the clinical benefit of first-line immunotherapy: a case report

Local radiotherapy in extensive-stage small-cell lung cancer sustainably boosts the clinical benefit of first-line immunotherapy: a case report

Role of consolidative thoracic and prophylactic cranial radiation in extensive stage small cell lung cancer in chemo-immunotherapy era

IntroductionThe role of consolidative thoracic and prophylactic brain radiation for extensive stage small cell lung cancer patients is controversial. We investigated the factors associated with the use of any radiation therapy (RT) and whether RT has a benefit to overall survival (OS) in patients receiving any systemic therapy and whether this benefit is the same if Chemotherapy (CT) or chemo-immunotherapy (CT-IO) is used. Material/MethodsThe NCDB database was queried from years 2017–2019. Patients receiving systemic therapy- STX (CT or CT-IO) had to have at least 6 months of follow-up and have no brain metastases at diagnosis. All RT patients had to receive upfront systemic therapy, be treated 2–6 months from diagnosis, and if treated to the brain received 25 Gy in 10 fractions only. Multi-variable analyses (MVA) were used to determine factors associated with OS and selection for any radiation. Propensity matching for factors affecting OS were used to generate Kaplan-Meier OS curves. Log-rank tests were used to determine differences in Kaplan Meier survival curves for the effects of RT on OS. ResultsThe total number of patients receiving RT/STX or STX alone as well as their median follow-up (months) were (890, 17.0 mn) and (6898, 14.0mn). The median time to the start of STX and RT were 22.9 days and 152 days, respectively. MVA noted that RT had a greater effect on OS (Thorax, Brain, Both Brain/Thorax – HRs = 0.80, 0.77, 0.70) than other interventions including IO (HR 0.87) and palliative care without RT (HR 1.06). Selection for radiation depended significantly upon factors affecting OS (HR) including lack of liver metastases, females, age and Charlson co-morbidity index, but did not depend upon insurance status, race, or county income/high school graduation rates. Propensity-score matched OS curves noted the same significant effects of RT on OS in those receiving CT +/- IO, CT-IO, and CT alone with HRs of 0.68/0.68/0.68 for thoracic RT, 0.72/0.72/0.70 for brain RT, and 0.60/0.60/0.60 for brain/thoracic RT, respectively. ConclusionsThe patient with extensive stage small cell lung cancer who reach candidacy and receive RT may have a significant improvement in OS compared to the patients treated only with CT or CT-IO. Combined thoracic and prophylactic brain RT seems to be better than either one alone. The impact of radiation whether given to one or two sites may be more beneficial than immunotherapy added to chemotherapy.

Non-invasive mechanical ventilation is a promising way to improve lung cancer radiotherapy

Non-invasive mechanical ventilation is a promising way to improve lung cancer radiotherapy

Robust Real-Time Cancer Tracking via Dual-Panel X-Ray Images for Precision Radiotherapy

Respiratory-induced tumor motion presents a critical challenge in lung cancer radiotherapy, potentially impacting treatment precision and efficacy. This study introduces an innovative, deep learning-based approach for real-time, markerless lung tumor tracking utilizing orthogonal X-ray projection images. It incorporates three key components: (1) a sophisticated data augmentation technique combining a hybrid deformable model with 3D thin-plate spline transformation, (2) a state-of-the-art Transformer-based segmentation network for precise tumor boundary delineation, and (3) a CNN regression network for accurate 3D tumor position estimation. We rigorously evaluated this approach using both patient data from The Cancer Imaging Archive and dynamic thorax phantom data, assessing performance across various noise levels and comparing it with current leading algorithms. For TCIA patient data, the average DSC and HD95 values were 0.9789 and 1.8423 mm, respectively, with an average centroid localization deviation of 0.5441 mm. On CIRS phantoms, DSCs were 0.9671 (large tumor) and 0.9438 (small tumor) with corresponding HD95 values of 1.8178 mm and 1.9679 mm. The 3D centroid localization accuracy was consistently below 0.33 mm. The processing time averaged 90 ms/frame. Even under high noise conditions (S2 = 25), errors for all data remained within 1 mm with tracking success rates mostly at 100%. In conclusion, the proposed markerless tracking method demonstrates superior accuracy, noise robustness, and real-time performance for lung tumor localization during radiotherapy. Its potential to enhance treatment precision, especially for small tumors, represents a significant step toward improving radiotherapy efficacy and personalizing cancer treatment.

Optimising hypoxia PET imaging and its applications in guiding targeted radiation therapy for non-small cell lung cancer: a scoping review.

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death. Definitive treatment includes chemotherapy and radiation therapy. Tumour hypoxia impacts the efficacy of these treatment modalities. Novel positron-emission tomography (PET) imaging has been developed to non-invasively quantify hypoxic tumour subregions, and to guide personalised treatment strategies. This review evaluates the reliability of hypoxia imaging in NSCLC in relation to various tracers, its correlations to treatment-related outcomes, and to assess if this imaging modality can be meaningfully applied into radiation therapy workflows. A literature search was conducted on the Medline (Ovid) and Embase databases. Searches included terms related to 'hypoxia', 'positron-emission tomography', 'magnetic resonance imaging' and 'lung cancer'. Results were filtered to exclude studies prior to 2011, and animal studies were excluded. Only studies referring to a confirmed pathology of NSCLC were included, while disease staging was not a limiting factor. Full-text English language and translated literature examined included clinical trials, clinical cohort studies and feasibility studies. Quantification of hypoxic volumes in a pre-treatment setting is of prognostic value, and indicative of treatment response. Dosimetric comparisons have highlighted potential to significantly dose escalate to hypoxic volumes without risk of additional toxicity. However, clinical data to support these strategies are lacking. Heterogenous study design and non-standardised imaging parameters have led to a lack of clarity regarding the application of hypoxia PET imaging in NSCLC. PET imaging using nitroimidazole tracers is the most investigated method of non-invasively measuring tumour hypoxia and has potential to guide hypoxia-targeted radiation therapy. Further clinical research is required to elucidate the benefits versus risks of dose-escalation strategies.

WHOLE BRAIN RADIOTHERAPY FOR INTRACRANIAL METASTATIC DISEASE IN NON-SMALL CELL LUNG CANCER: THE WESSEX EXPERIENCE

Abstract AIMS The QUARTZ trial (2016) reported that corticosteroid therapy was non-inferior to whole brain radiotherapy(WBRT) for non-small cell lung cancer (NSCLC) with regards overall survival(OS). This is a single centre experience of WBRT for NSCLC in the post-QUARTZ era and in the context of the changes in clinical practice over the past 8 years. METHOD Single centre retrospective observational study. Patients included with NSCLC treated with WBRT for radiologically confirmed intracranial (IC) metastatic disease January 2018 to December 2022. OS, baseline tumour/patient characteristics and lines of treatment were recorded from medical records. Data compiled using Excel and statistical analysis using the R language for statistical programming. RESULTS 62 patients were included, median age 64 (37 -82). 29(46.8%) were Performance status 0-1. 50(80.6%) received 20Gy in 5 fractions, 12(19.4%) received 30Gy in 10 fractions. PDL1 &amp;gt;50% in 14(22.6%), EGFR mutation positive in 10(16.1%), 0(0%) ALK/ROS mutations. 9(14.5%) had received prior radiotherapy(RT) for IC disease (SRS:8, partial brain VMAT:1). 20(32.3%) had IC disease at presentation. Median OS 68 days (95%CI:58-111;range12-777) in keeping with QUARTZ results (median OS 65 days, 95%CI:50- 78). Univariate analyses demonstrated: subsequent systemic therapy (p=0.0022), receiving immunotherapy (p=0.002) and baseline performance status (p=0.0017) associated with improved OS. PDL1 &amp;gt;50%, EGFR mutation positive, RT dose, prior systemic therapy, histological subtype, presence of a targetable mutation, first or subsequent IC treatment did not predict survival. The chi-squared test was used to compare differences in the groups with OS&amp;gt;100days(n=22) and OS&amp;lt;100days(n=40). Systemic therapy after WBRT(p=0.0011) and immunotherapy treatment(p=0.0092) were significant differences between the cohorts and associated with improved survival. CONCLUSION This data supports conclusions of QUARTZ study and it remains difficult to define a role for WBRT in the management of IC disease in NSCLC. There is a cohort who have better OS, though we believe this may be related to systemic therapy (particularly immunotherapy) exposure.

A cascaded FAS-UNet+ framework with iterative optimization strategy for segmentation of organs at risk.

Segmentation of organs at risks (OARs) in the thorax plays a critical role in radiation therapy for lung and esophageal cancer. Although automatic segmentation of OARs has been extensively studied, it remains challenging due to the varying sizes and shapes of organs, as well as the low contrast between the target and background. This paper proposes a cascaded FAS-UNet+ framework, which integrates convolutional neural networks and nonlinear multi-grid theory to solve a modified Mumford-shah model for segmenting OARs. This framework is equipped with an enhanced iteration block, a coarse-to-fine multiscale architecture, an iterative optimization strategy, and a model ensemble technique. The enhanced iteration block aims to extract multiscale features, while the cascade module is used to refine coarse segmentation predictions. The iterative optimization strategy improves the network parameters to avoid unfavorable local minima. An efficient data augmentation method is also developed to train the network, which significantly improves its performance. During the prediction stage, a weighted ensemble technique combines predictions from multiple models to refine the final segmentation. The proposed cascaded FAS-UNet+ framework was evaluated on the SegTHOR dataset, and the results demonstrate significant improvements in Dice score and Hausdorff Distance (HD). The Dice scores were 95.22%, 95.68%, and HD values were 0.1024, and 0.1194 for the segmentations of the aorta and heart in the official unlabeled dataset, respectively. Our code and trained models are available at https://github.com/zhuhui100/C-FASUNet-plus .

P3.08F.04 Developing Circulating and Imaging Biomarkers Towards Personalised Radiotherapy in Lung Cancer: An Update on the VIGILANCE Study

P3.08F.04 Developing Circulating and Imaging Biomarkers Towards Personalised Radiotherapy in Lung Cancer: An Update on the VIGILANCE Study

EP.15B.01 Effect of Mindfulness-Based Stress Reduction Psychological Intervention on Anxiety and Depression in Patients with Lung Cancer Radiotherapy

EP.15B.01 Effect of Mindfulness-Based Stress Reduction Psychological Intervention on Anxiety and Depression in Patients with Lung Cancer Radiotherapy

P46-3 Case series on stereotactic body radiation therapy in primary lung cancer & metastases: early experiences from Indonesia

P46-3 Case series on stereotactic body radiation therapy in primary lung cancer & metastases: early experiences from Indonesia

EP.07B.01 Definitions of Local Control after Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer Reported in the Literature

EP.07B.01 Definitions of Local Control after Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer Reported in the Literature

EP.07B.05 Comparison of Image-Guided Thermal Ablation or Stereotactic Body Radiation Therapy for Primary Non-Small Cell Lung Cancer

EP.07B.05 Comparison of Image-Guided Thermal Ablation or Stereotactic Body Radiation Therapy for Primary Non-Small Cell Lung Cancer

EP.13C.02 High-Dose Radiation Therapy for Limited-Stage Small-Cell Lung Cancer: Real-World Experience from Two Tertiary Centers

EP.13C.02 High-Dose Radiation Therapy for Limited-Stage Small-Cell Lung Cancer: Real-World Experience from Two Tertiary Centers