Alyssa Gadsby MS, Tian Liu PhD, Robert Samstein MD, Jiahan Zhang PhD, Yang Lei PhD, Kenneth E. Rosenzweig MD, Ming Chao PhD
{"title":"正常肺容量选择对局部非小细胞肺癌放射治疗中放射性肺炎风险预测的影响","authors":"Alyssa Gadsby MS, Tian Liu PhD, Robert Samstein MD, Jiahan Zhang PhD, Yang Lei PhD, Kenneth E. Rosenzweig MD, Ming Chao PhD","doi":"10.1016/j.adro.2025.101825","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the impact of varying definitions of normal lung volume on the prediction of radiation pneumonitis (RP) risk in patients with locally advanced non-small cell lung cancer undergoing radiation therapy.</div></div><div><h3>Methods and Materials</h3><div>Dosimetric variables V20, V5, and mean lung dose (MLD) were extracted from the treatment plans of 442 patients enrolled in the NRG Oncology Radiation Therapy Oncology Group 0617 trial. Three different definitions of lung volume were evaluated: total lung excluding gross tumor target, total lung excluding clinical target volume, and total lung excluding planning target volume (TL-PTV). Patients were grouped as “no-RP2” (<em>N</em> = 377, grade ≤1 RP) and “RP2” (<em>N</em> = 65, grade ≥2 RP). Statistical analyses were performed to assess the effect of lung volume definition on RP2 prediction. Three supervised machine learning models—logistic regression, k-nearest neighbor (kNN), and eXtreme Gradient Boosting—were used to evaluate predictive performance. Model performance was quantified using the area under the receiver operating characteristic curve, and statistical significance was tested via a bootstrap analysis. Shapley Additive Explanations (SHAP) were applied to interpret feature contributions to model predictions.</div></div><div><h3>Results</h3><div>Statistical analyses showed that V20 and MLD were significantly associated with RP2, while differences among the lung volume definitions were not statistically significant. Both k-nearest neighbor and eXtreme Gradient Boosting classifiers consistently yielded higher area under the receiver operating characteristic curve values for the TL-PTV definition compared to the other definitions, a finding supported by bootstrap analysis. SHAP analysis further indicated that V20 and MLD were the most influential predictors of RP2.</div></div><div><h3>Conclusions</h3><div>In line with previous studies, both statistical analysis and SHAP interpretation confirmed that V20 and MLD were associated with RP2. The machine learning models indicated that defining normal lung volume as TL-PTV yielded the highest predictive performance for RP2 risk. Further validation using external data sets are warranted to confirm these findings.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101825"},"PeriodicalIF":2.7000,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Normal Lung Volume Choices on Radiation Pneumonitis Risk Prediction in Locally Non-small Cell Lung Cancer Radiation Therapy\",\"authors\":\"Alyssa Gadsby MS, Tian Liu PhD, Robert Samstein MD, Jiahan Zhang PhD, Yang Lei PhD, Kenneth E. Rosenzweig MD, Ming Chao PhD\",\"doi\":\"10.1016/j.adro.2025.101825\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>This study aims to evaluate the impact of varying definitions of normal lung volume on the prediction of radiation pneumonitis (RP) risk in patients with locally advanced non-small cell lung cancer undergoing radiation therapy.</div></div><div><h3>Methods and Materials</h3><div>Dosimetric variables V20, V5, and mean lung dose (MLD) were extracted from the treatment plans of 442 patients enrolled in the NRG Oncology Radiation Therapy Oncology Group 0617 trial. Three different definitions of lung volume were evaluated: total lung excluding gross tumor target, total lung excluding clinical target volume, and total lung excluding planning target volume (TL-PTV). Patients were grouped as “no-RP2” (<em>N</em> = 377, grade ≤1 RP) and “RP2” (<em>N</em> = 65, grade ≥2 RP). Statistical analyses were performed to assess the effect of lung volume definition on RP2 prediction. Three supervised machine learning models—logistic regression, k-nearest neighbor (kNN), and eXtreme Gradient Boosting—were used to evaluate predictive performance. Model performance was quantified using the area under the receiver operating characteristic curve, and statistical significance was tested via a bootstrap analysis. Shapley Additive Explanations (SHAP) were applied to interpret feature contributions to model predictions.</div></div><div><h3>Results</h3><div>Statistical analyses showed that V20 and MLD were significantly associated with RP2, while differences among the lung volume definitions were not statistically significant. Both k-nearest neighbor and eXtreme Gradient Boosting classifiers consistently yielded higher area under the receiver operating characteristic curve values for the TL-PTV definition compared to the other definitions, a finding supported by bootstrap analysis. SHAP analysis further indicated that V20 and MLD were the most influential predictors of RP2.</div></div><div><h3>Conclusions</h3><div>In line with previous studies, both statistical analysis and SHAP interpretation confirmed that V20 and MLD were associated with RP2. The machine learning models indicated that defining normal lung volume as TL-PTV yielded the highest predictive performance for RP2 risk. Further validation using external data sets are warranted to confirm these findings.</div></div>\",\"PeriodicalId\":7390,\"journal\":{\"name\":\"Advances in Radiation Oncology\",\"volume\":\"10 8\",\"pages\":\"Article 101825\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-07-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Advances in Radiation Oncology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2452109425001125\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Advances in Radiation Oncology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2452109425001125","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Impact of Normal Lung Volume Choices on Radiation Pneumonitis Risk Prediction in Locally Non-small Cell Lung Cancer Radiation Therapy
Purpose
This study aims to evaluate the impact of varying definitions of normal lung volume on the prediction of radiation pneumonitis (RP) risk in patients with locally advanced non-small cell lung cancer undergoing radiation therapy.
Methods and Materials
Dosimetric variables V20, V5, and mean lung dose (MLD) were extracted from the treatment plans of 442 patients enrolled in the NRG Oncology Radiation Therapy Oncology Group 0617 trial. Three different definitions of lung volume were evaluated: total lung excluding gross tumor target, total lung excluding clinical target volume, and total lung excluding planning target volume (TL-PTV). Patients were grouped as “no-RP2” (N = 377, grade ≤1 RP) and “RP2” (N = 65, grade ≥2 RP). Statistical analyses were performed to assess the effect of lung volume definition on RP2 prediction. Three supervised machine learning models—logistic regression, k-nearest neighbor (kNN), and eXtreme Gradient Boosting—were used to evaluate predictive performance. Model performance was quantified using the area under the receiver operating characteristic curve, and statistical significance was tested via a bootstrap analysis. Shapley Additive Explanations (SHAP) were applied to interpret feature contributions to model predictions.
Results
Statistical analyses showed that V20 and MLD were significantly associated with RP2, while differences among the lung volume definitions were not statistically significant. Both k-nearest neighbor and eXtreme Gradient Boosting classifiers consistently yielded higher area under the receiver operating characteristic curve values for the TL-PTV definition compared to the other definitions, a finding supported by bootstrap analysis. SHAP analysis further indicated that V20 and MLD were the most influential predictors of RP2.
Conclusions
In line with previous studies, both statistical analysis and SHAP interpretation confirmed that V20 and MLD were associated with RP2. The machine learning models indicated that defining normal lung volume as TL-PTV yielded the highest predictive performance for RP2 risk. Further validation using external data sets are warranted to confirm these findings.
期刊介绍:
The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.