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

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• 作者：Adam L. Liss ; MD^&lowast ; ; ^{adamliss68@gmail.com} ; Robin B. Marsh ; CMD^&lowast ; ; Nirav S. Kapadia ; MD^&dagger ; ; Daniel L. McShan ; PhD^&lowast ; ; Virginia E. Rogers ; BS^&Dagger ; ; James M. Balter ; PhD^&lowast ; ; Jean M. Moran ; PhD^&lowast ; ; Kristy K. Brock ; PhD^&lowast ; ; Matt J. Schipper ; PhD^&lowast ; ; Reshma Jagsi ; MD ; DPhil^&lowast ; ; Kent A. Griffith ; MPH ; MS^§ ; ; Kevin R. Flaherty ; MD ; MS^|| ; Kirk A. Frey ; MD ; PhD^&Dagger ; ; Lori J. Pierce ; MD^&lowast ;
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：97
• 期：2
• 页码：296-302
• 全文大小：726 K
• 卷排序：97

文摘

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.Methods and MaterialsAs 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.ResultsFifty 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).ConclusionsIn 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.