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A Phase 2 Randomized Clinical Trial Evaluating 4-Dimensional Computed Tomography Ventilation-Based Functional Lung Avoidance Radiation Therapy for Non-Small Cell Lung Cancer.
Baschnagel, Andrew M; Flakus, Mattison J; Wallat, Eric M; Wuschner, Antonia E; Chappell, Richard J; Bayliss, R Adam; Kimple, Randall J; Christensen, Gary E; Reinhardt, Joseph M; Bassetti, Michael F; Bayouth, John E.
Afiliação
  • Baschnagel AM; Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin. Electronic address: baschnagel@humonc.wisc.edu.
  • Flakus MJ; Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.
  • Wallat EM; Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.
  • Wuschner AE; Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.
  • Chappell RJ; Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin.
  • Bayliss RA; Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
  • Kimple RJ; Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
  • Christensen GE; Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa; Department of Radiation Oncology, University of Iowa, Iowa City, Iowa.
  • Reinhardt JM; Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa.
  • Bassetti MF; Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
  • Bayouth JE; Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon. Electronic address: bayouth@ohsu.edu.
Int J Radiat Oncol Biol Phys ; 119(5): 1393-1402, 2024 Aug 01.
Article em En | MEDLINE | ID: mdl-38387810
ABSTRACT

PURPOSE:

To determine whether 4-dimensional computed tomography (4DCT) ventilation-based functional lung avoidance radiation therapy preserves pulmonary function compared with standard radiation therapy for non-small cell lung cancer (NSCLC). METHODS AND MATERIALS This single center, randomized, phase 2 trial enrolled patients with NSCLC receiving curative intent radiation therapy with either stereotactic body radiation therapy or conventionally fractionated radiation therapy between 2016 and 2022. Patients were randomized 11 to standard of care radiation therapy or functional lung avoidance radiation therapy. The primary endpoint was the change in Jacobian-based ventilation as measured on 4DCT from baseline to 3 months postradiation. Secondary endpoints included changes in volume of high- and low-ventilating lung, pulmonary toxicity, and changes in pulmonary function tests (PFTs).

RESULTS:

A total of 122 patients were randomized and 116 were available for analysis. Median follow up was 29.9 months. Functional avoidance plans significantly (P < .05) reduced dose to high-functioning lung without compromising target coverage or organs at risk constraints. When analyzing all patients, there was no difference in the amount of lung showing a reduction in ventilation from baseline to 3 months between the 2 arms (1.91% vs 1.87%; P = .90). Overall grade ≥2 and grade ≥3 pulmonary toxicities for all patients were 24.1% and 8.6%, respectively. There was no significant difference in pulmonary toxicity or changes in PFTs between the 2 study arms. In the conventionally fractionated cohort, there was a lower rate of grade ≥2 pneumonitis (8.2% vs 32.3%; P = .049) and less of a decline in change in forced expiratory volume in 1 second (-3 vs -5; P = .042) and forced vital capacity (1.5 vs -6; P = .005) at 3 months, favoring the functional avoidance arm.

CONCLUSIONS:

There was no difference in posttreatment ventilation as measured by 4DCT between the arms. In the cohort of patients treated with conventionally fractionated radiation therapy with functional lung avoidance, there was reduced pulmonary toxicity, and less decline in PFTs suggesting a clinical benefit in patients with locally advanced NSCLC.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Carcinoma Pulmonar de Células não Pequenas / Tomografia Computadorizada Quadridimensional / Pulmão / Neoplasias Pulmonares Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Int J Radiat Oncol Biol Phys Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Carcinoma Pulmonar de Células não Pequenas / Tomografia Computadorizada Quadridimensional / Pulmão / Neoplasias Pulmonares Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Int J Radiat Oncol Biol Phys Ano de publicação: 2024 Tipo de documento: Article