非小细胞肺癌患者放疗期间和放疗后镓-68通气和灌注PET/CT的前瞻性先导研究

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-10-10 DOI:10.1016/j.radonc.2025.111179

Neil D. Wallace , Mathias Bressel , Nick Hardcastle , Lachlan McIntosh , Nick Bucknell , Tomas Kron , Jason Callahan , Rod Hicks , David Ball , Michael MacManus , Nikki Plumridge , Mark Shaw , Daniel Steinfort , Lisa Selbie , Michael Hofman , Shankar Siva

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引用次数: 0

摘要

目的：利用68镓（Ga）通气-灌注（V/Q） 4维（4D） PET/CT研究治疗性放疗（RT）剂量对肺通气和灌注的影响，并评价其与临床预后的关系。方法和材料：这项前瞻性非随机观察性临床试验包括67例接受终末期非小细胞肺癌放疗+/-化疗的患者。患者在基线、治疗中期、治疗后3个月和12个月接受68Ga 4D V/Q PET/CT检查。在基线和治疗后3个月评估肺功能测试（PFTs）和毒性。采用线性混合模型评估放疗剂量-体积与毒性之间的关系，放疗剂量-体积分别应用于通气肺和灌注肺，阈值分别为5 %、30 %和70 % （68Ga 4D V/Q PET/CT定义）。结果：67例患者可评估，其中男性44例（66 %），平均年龄68岁，61例（91 %）ECOG 0-1。63例患者完成治疗，20例发生≥2级肺炎（32% %）。治疗后3个月，肺通气和灌注、FEV1和DLCO较基线略有下降。≥2级肺炎患者在30 %阈值时灌注肺V54 Gy较高(中位数12.9 % （IQR 8.7-14.8 %)vs 6.3 % (IQR 3.7-8.5 %),p = 0.003）。≥2级肺炎与通气肺（p = 0.12）或灌注肺（p = 0.14）的绝对变化无相关性。结论：我们观察到68Ga 4D V/Q PET/CT从基线到3 个月后肺通气和灌注减少。接受接近治疗剂量的RT的肺灌注良好的体积与≥2级肺炎的发展之间的关系值得进一步研究。

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A prospective study of Gallium-68 ventilation and perfusion PET/CT during and after radiotherapy in patients with non-small cell lung cancer

Purpose

To utilize ⁶⁸Gallium (Ga) Ventilation-Perfusion (V/Q) 4-dimensional (4D) PET/CT to establish the impact of curative radiotherapy (RT) doses on lung ventilation and perfusion, and to evaluate associations with clinical outcomes.

Methods and materials

This prospective non-randomized observational clinical trial included 67 patients undergoing definitive RT +/-chemotherapy for NSCLC. Patients underwent ⁶⁸Ga 4D V/Q PET/CT at baseline, mid-treatment, and at 3- and 12-months post-treatment. Pulmonary Function Tests (PFTs) and toxicities were assessed at baseline and 3 monthly after treatment. Linear mixed models were used to assess for associations between radiotherapy dose-volume, applied to ventilated and perfused lung at 5 %, 30 % and 70 % thresholds as defined by ⁶⁸Ga 4D V/Q PET/CT, and toxicity.

Results

Sixty-seven patients were evaluable, of whom 44 (66 %) were male, mean age was 68, and 61 (91 %) were ECOG 0–1. Sixty-three patients completed treatment and grade ≥2 pneumonitis occurred in 20 (32 %). Lung ventilation and perfusion, and FEV1 and DLCO, fell slightly from baseline to 3-months post treatment. V54 Gy of perfused lung at the 30 % threshold was higher in those with grade ≥2 pneumonitis (median 12.9 % (IQR 8.7–14.8 %) vs 6.3 % (IQR 3.7–8.5 %), p = 0.003). No association between grade ≥2 pneumonitis and the absolute change in ventilated (p = 0.12) or perfused (p = 0.14) lung was observed.

Conclusions

We observed a decrease in lung ventilation and perfusion on ⁶⁸Ga 4D V/Q PET/CT from baseline to 3 months after RT. The association between the volume of well-perfused lung receiving near-therapeutic RT doses and the development of grade ≥2 pneumonitis warrants future investigation.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.