A novel optimization of cone beam CT frequency for lung radiation therapy based on an image-guided radiation therapy protocol and patient classification method.

IF 4 2区 医学 Q2 ONCOLOGY
Translational lung cancer research Pub Date : 2025-01-24 Epub Date: 2025-01-21 DOI:10.21037/tlcr-24-606
Jinghao Zhou, Arun Gopal, Baoshe Zhang, Huijun Xu, Shifeng Chen, ByongYong Yi, Giovanni Lasio
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引用次数: 0

Abstract

Background: Cone beam computed tomography (CBCT) is a standard imaging modality in the management of lung cancer with radiation therapy. The optimal frequency of CBCT imaging during a course of radiotherapy is not currently strongly defined for many anatomical sites, including lung, and in clinical practice typically ranges from daily to weekly. There is a trade-off between clinical benefit derived from optimal soft tissue targeting with daily CBCT and the increased non-therapeutic dose that such imaging regimen entails. The aim of this study is to address this matter by proposing a new image-guided radiation therapy (IGRT) protocol and a patient classification method to achieve an optimal CBCT frequency for conventionally fractionated lung cancer radiation therapy.

Methods: This Institutional Review Board (IRB)-approved study analyzes 110 lung cancer patients, with a total of 1616 CBCTs during treatment. The in-house IGRT protocol involves daily CBCT for the first three fractions followed by weekly CBCT for soft tissue alignment, along with daily kV-orthogonal for bony anatomy alignment. The eligibility of patient of using this IGRT protocol is determined by a criterion based on numbers of CBCT position matches (equal to 3 fractions match in the first three CBCTs, or great than or equal to 3 fractions match in the first four CBCTs). The fraction matching threshold values 40-70% of protocol-eligible group (eGroup) were applied, as well as the setup threshold (ST) values of 3, 4, and 5 mm were applied, respectively. Sensitivities, specificities and accuracies were computed to quantitate our proposed classification method.

Results: With ST at 3, 4, and 5 mm, with the best fraction matching threshold of 50% found in current dataset, the eGroup included 83.5%, 96.2%, and 98.7% of patients, respectively. More patients are eligible to IGRT protocol if a larger pre-defined ST is used. Sensitivities for identifying a protocol-ineligible group (iGroup) patient were 0.69, 1.0, and 1.0, specificities for identifying an eGroup patient were 0.85, 0.93, and 0.96, while accuracies were 0.82, 0.94 and 0.96, respectively.

Conclusions: We have proposed a new patient classification approach in the context of an IGRT protocol with optimized CBCT frequency for conventionally fractionated lung cancer radiation therapy. The first three CBCT helps predict patient eligibility of this IGRT protocol. We have evaluated different threshold criteria and found high sensitivity, specificities and accuracies are achievable. This study supports that weekly CBCT is sufficient for the most of the lung patients. The same method, proposed adaptive classification approach in this study, might also be applied for other anatomic sites.

基于图像引导放射治疗方案和患者分类方法的肺放射治疗锥形束CT频率优化。
背景:锥形束计算机断层扫描(CBCT)是肺癌放射治疗的标准成像方式。目前,对于包括肺在内的许多解剖部位,在放疗过程中CBCT成像的最佳频率还没有明确的定义,在临床实践中,CBCT成像的频率通常为每天到每周。每日CBCT的最佳软组织靶向所带来的临床益处与这种成像方案所带来的非治疗剂量的增加之间存在权衡。本研究的目的是通过提出一种新的图像引导放射治疗(IGRT)方案和患者分类方法来解决这一问题,以实现常规分级肺癌放射治疗的最佳CBCT频率。方法:这项机构审查委员会(IRB)批准的研究分析了110例肺癌患者,治疗期间共有1616例cbct。内部IGRT方案包括每日CBCT检查前三个部分,然后每周CBCT检查软组织对齐,以及每日kv正交检查骨骼解剖对齐。根据CBCT位置匹配次数(前三次CBCT中等于3个分数匹配,或前四次CBCT中大于或等于3个分数匹配)确定患者是否符合本IGRT方案。采用符合方案组(eGroup)的分数匹配阈值40-70%,设置阈值(ST)分别为3、4、5 mm。通过计算灵敏度、特异性和准确度来量化我们提出的分类方法。结果:当ST为3,4,5 mm时,在当前数据集中发现的最佳分数匹配阈值为50%,eGroup分别纳入了83.5%,96.2%和98.7%的患者。如果使用更大的预定义ST,更多的患者符合IGRT方案。识别方案不合格组(iggroup)患者的敏感性分别为0.69、1.0和1.0,识别eGroup患者的特异性分别为0.85、0.93和0.96,准确性分别为0.82、0.94和0.96。结论:我们在IGRT方案的背景下提出了一种新的患者分类方法,该方案具有优化的CBCT频率,用于常规分级肺癌放射治疗。前三次CBCT有助于预测该IGRT方案的患者资格。我们评估了不同的阈值标准,发现高灵敏度,特异性和准确性是可以实现的。本研究支持每周CBCT对大多数肺部患者是足够的。同样的方法,本研究提出的自适应分类方法,也可能适用于其他解剖部位。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.20
自引率
2.50%
发文量
137
期刊介绍: Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.
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