![]() The 1- and 2-year OS were 75% and 60% respectively. 10% had pre-existing ischaemic heart disease. ![]() Median follow-up duration was 30.4 months (2.3- 81.9). Twenty eligible patients were identified. Univariate cox regression was performed using Stata version 13. Clinical data and dosimetric parameters affecting overall survival were collected from the institutional electronic medical records as well as the national death and acute myocardial infarction registries. ![]() Study eligibility criteria included stage I to III NSCLC treated with PORT at two institutions from 2007 to 2014. Hence we performed this study to determine the impact of pre-existing ischaemic heart disease and radiation heart dose on OS in NSCLC patients treated with PORT using contemporary radiation techniques. Post-operative thoracic radiotherapy (PORT) delivered via non-modern radiation techniques had also been shown to increase cardiac mortality. Recent randomized and observational studies suggested that pre-existing cardiac disease and higher radiation heart doses were associated with more cardiac events and worse overall survival (OS) in locally-advanced non-small cell lung cancer (NSCLC) treated with definitive chemoradiation. To achieve reduced irradiation of functional lung, radiotherapy adaptation is more effectively facilitated by perfusion rather than ventilation imaging. Plans optimised to HPLung resulted in a reduction of perfused lung V5 by a mean of 13.2%, p<0.01, with HVlung plans yielding a decrease in ventilated lung V5 of 9.6%, p=0.02. ![]() Functional MLD of HPLung decreased by a mean of 7.3%, p=0.02. Plan quality was consistent with the median PTV D95 ranging from 60.6-61.3Gy, and mean conformity index ranging from 1.23-1.25. Increase in ventilated function was most prevalent adjacent to the target, limiting the benefit of adaptive planning (Fig 1). HPLung decreased by a median value of 4.5% with spatial discrepancy represented by DSC of 0.568-0.805. Subsequent volumetric and spatial changes were reflected in varying DICE similarity coefficients, or DSC (ranging from 0.336-0.923). HVLung volume increased between scans by a median value of 39.2%. PTV volumes reduced by a mean of 5.5% between scans. The study cohort consisted of 10 patients resulting in a total of 30 VMAT plans. Plan quality was assessed for consistency with respect to conformity indices, and doses to critical structures. Functional dose volumetrics were assessed using the parameters of mean lung dose (MLD), and lung volume receiving 5, 20 or 30Gy, (V5, V20, and V30). Three VMAT plans were created on the mid-treatment datatsets: optimised to anatomical lung, HPLung, and HVLung volumes, respectively. Functional lung volumes were delineated on both datasets as ‘highly perfused’ (HPLung) and ‘highly ventilated’ (HVLung), using a 70 centile SUV threshold. In a prospective clinical trial, patients with non-small cell lung cancer (NSCLC) underwent Ga-4D-V/Q PET/CT scanning before and during a six-week (60Gy) course of definitive chemoradiation. To assess the utility of four-dimensional (4D) ventilation/perfusion (V/Q) PET/CT lung imaging to facilitate mid-radiotherapy treatment adaption with volumetric modulated arc radiotherapy (VMAT).
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