Decreased Lung Perfusion After Breast/Chest Wall Irradiation: Quantitative Results From a Prospective Clinical Trial

Autor: Reshma Jagsi, Jean M. Moran, Adam L. Liss, Virginia E. Rogers, James M. Balter, Kent A. Griffith, Nirav S. Kapadia, Kristy K. Brock, Kirk A. Frey, Kevin R. Flaherty, Lori J. Pierce, M.J. Schipper, Daniel L. McShan, Robin B. Marsh
Rok vydání: 2017
Předmět:
Adult
Cancer Research
medicine.medical_specialty
medicine.medical_treatment
Antineoplastic Agents
Perfusion scanning
Single-photon emission computed tomography
Mastectomy
Segmental
Radiation Dosage
Article
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Breast cancer
Confidence Intervals
Unilateral Breast Neoplasms
medicine
Humans
Radiology
Nuclear Medicine and imaging
Postoperative Period
Prospective Studies
skin and connective tissue diseases
Prospective cohort study
Lung
Mastectomy
Aged
Tomography
Emission-Computed
Single-Photon
Radiation
medicine.diagnostic_test
business.industry
Radiotherapy Planning
Computer-Assisted
Middle Aged
medicine.disease
Radiation therapy
medicine.anatomical_structure
Oncology
030220 oncology & carcinogenesis
Female
Lymph Nodes
Radiotherapy
Intensity-Modulated
Radiology
Radiotherapy
Conformal
Nuclear medicine
business
Perfusion
Emission computed tomography
Zdroj: International Journal of Radiation Oncology*Biology*Physics. 97:296-302
ISSN: 0360-3016
DOI: 10.1016/j.ijrobp.2016.10.012
Popis: To quantify lung perfusion changes after breast/chest wall radiation therapy (RT) using pre- and post-RT single photon emission computed tomography/computed tomography (SPECT/CT) attenuation-corrected perfusion scans; and correlate decreased perfusion with adjuvant RT dose for breast cancer in a prospective clinical trial.As part of an institutional review board-approved trial studying the impact of RT technique on lung function in node-positive breast cancer, patients received breast/chest wall and regional nodal irradiation including superior internal mammary node RT to 50 to 52.2 Gy with a boost to the tumor bed/mastectomy scar. All patients underwent quantitative SPECT/CT lung perfusion scanning before RT and 1 year after RT. The SPECT/CT scans were co-registered, and the ratio of decreased perfusion after RT relative to the pre-RT perfusion scan was calculated to allow for direct comparison of SPECT/CT perfusion changes with delivered RT dose. The average ratio of decreased perfusion was calculated in 10-Gy dose increments from 0 to 60 Gy.Fifty patients had complete lung SPECT/CT perfusion data available. No patient developed symptoms consistent with pulmonary toxicity. Nearly all patients demonstrated decreased perfusion in the left lung according to voxel-based analyses. The average ratio of lung perfusion deficits increased for each 10-Gy increment in radiation dose to the lung, with the largest changes in regions of lung that received 50 to 60 Gy (ratio 0.72 [95% confidence interval 0.64-0.79], P.001) compared with the 0- to 10-Gy region. For each increase in 10 Gy to the left lung, the lung perfusion ratio decreased by 0.06 (P.001).In the assessment of 50 patients with node-positive breast cancer treated with RT in a prospective clinical trial, decreased lung perfusion by SPECT/CT was demonstrated. Our study allowed for quantification of lung perfusion defects in a prospective cohort of breast cancer patients for whom attenuation-corrected SPECT/CT scans could be registered directly to RT treatment fields for precise dose estimates.
Databáze: OpenAIRE
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