Program Information
Preserving Functional Lung Using 4DCT-Ventilation Imaging and Proton Therapy for Locally Advanced Non-Small-Cell Lung Cancer
Q Huang1,2*, S Jabbour2 , Z Xiao2,3 , N Yue2 , K Nie2 , (1) Memorial Sloan-Kettering Cancer Center, New York, NY, (2) Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical, New Brunswick, NJ, (3) Proton Therapy Center, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH
Presentations
SU-H1-GePD-J(B)-1 (Sunday, July 30, 2017) 3:00 PM - 3:30 PM Room: Joint Imaging-Therapy ePoster Lounge - B
Purpose: To incorporate 4DCT ventilation imaging into functional treatment planning that preserves high-functional lung with both double scattering and scanning beam techniques.
Methods: Ten patients with locally advanced non-small-cell lung cancer were included in this study. Deformable image registration was performed for each patient on their planning 4DCTs and the resultant displacement vector field with Jacobian analysis was used to identify the high-, medium- and low-functoinal lung regions. Five plans were designed for each patient: a regular photon IMRT vs. anatomic proton plans without consideration of functional ventilation information using double scatter proton therapy (DSPT) and intensity modulated proton therapy (IMPT) vs. functional proton plans with avoidance of high-functional lung using both DSPT and IMPT. Dosimetric parameters were compared in terms of tumor coverage, plan heterogeneity, and avoidance of normal tissues.
Results: Both DSPT and IMPT plans showed superior dose advantages to photon IMRTs. The median reductions in the percentage of volume irradiated with >5 Gy, and >20 Gy in high-functional lung were 22.9%[11.8-32.5%] and 5.3%[0% -15.4%] for anatomical proton plans, and further to 28.2%[14.1-38.1%] and 7.5% [0.8%-19.2%] for functional proton plans compared to IMRT.The median reduction in the mean dose to the high-functional lung were 4.1Gy[0.55-8.6Gy] for anatomical plans, and further to 5.2Gy[1.9-10.3Gy] for functional proton plans. Significantly larger changes occurred in the metrics for patients with a larger amount of high-functional lung adjacent to the PTV. The functional DSPT plans also showed dose reduction for high-functional regions but not statistically significant compared to anatomical DSPT.
Conclusion: Incorporating 4DCT ventilation imaging into functional proton therapy is feasible. Proton plans are in general superior in preserving normal lung regions compared to IMRT and the functional proton plans are effective to furtherly preserve high-functional lung regions.
Funding Support, Disclosures, and Conflict of Interest: Cancer Center Support Grant P30CA072720 RBHS Precision Medicine Pilot Grant
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