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01.02.2016 | Original Article

Cone-beam CT-guided radiotherapy in the management of lung cancer

Diagnostic and therapeutic value

verfasst von: Khaled Elsayad, M.D., Jan Kriz, M.D., Gabriele Reinartz, M.D., Sergiu Scobioala, M.D., Iris Ernst, M.D., Uwe Haverkamp, Ph.D., Prof. Hans Theodor Eich, M.D. Ph.D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 2/2016

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Abstract

Background

Recent studies have demonstrated an increase in the necessity of adaptive planning over the course of lung cancer radiation therapy (RT) treatment. In this study, we evaluated intrathoracic changes detected by cone-beam CT (CBCT) in lung cancer patients during RT.

Methods and materials

A total of 71 lung cancer patients treated with fractionated CBCT-guided RT were evaluated. Intrathoracic changes and plan adaptation priority (AP) scores were compared between small cell lung cancer (SCLC, n = 13) and non-small cell lung cancer (NSCLC, n = 58) patients.

Results

The median cumulative radiation dose administered was 54 Gy (range 30–72 Gy) and the median fraction dose was 1.8 Gy (range 1.8–3.0 Gy). All patients were subjected to a CBCT scan at least weekly (range 1–5/week). We observed intrathoracic changes in 83 % of the patients over the course of RT [58 % (41/71) regression, 17 % (12/71) progression, 20 % (14/71) atelectasis, 25 % (18/71) pleural effusion, 13 % (9/71) infiltrative changes, and 10 % (7/71) anatomical shift]. Nearly half, 45 % (32/71), of the patients had one intrathoracic soft tissue change, 22.5 % (16/71) had two, and three or more changes were observed in 15.5 % (11/71) of the patients. Plan modifications were performed in 60 % (43/71) of the patients. Visual volume reduction did correlate with the number of CBCT scans acquired (r = 0.313, p = 0.046) and with the timing of chemotherapy administration (r = 0.385, p = 0.013).

Conclusion

Weekly CBCT monitoring provides an adaptation advantage in patients with lung cancer. In this study, the monitoring allowed for plan adaptations due to tumor volume changes and to other anatomical changes.

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Titel: Cone-beam CT-guided radiotherapy in the management of lung cancer
Diagnostic and therapeutic value
verfasst von: Khaled Elsayad, M.D.
Jan Kriz, M.D.
Gabriele Reinartz, M.D.
Sergiu Scobioala, M.D.
Iris Ernst, M.D.
Uwe Haverkamp, Ph.D.
Prof. Hans Theodor Eich, M.D. Ph.D.
Publikationsdatum: 01.02.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 2/2016
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-015-0927-y

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Cone-beam CT-guided radiotherapy in the management of lung cancer

Diagnostic and therapeutic value