Quantification of accumulated dose and associated anatomical changes of esophagus using weekly Magnetic Resonance Imaging acquired during radiotherapy of locally advanced lung cancer Journal Article
| Authors: | Alam, S.; Thor, M.; Rimner, A.; Tyagi, N.; Zhang, S. Y.; Kuo, L. C.; Nadeem, S.; Lu, W.; Hu, Y. C.; Yorke, E.; Zhang, P. |
| Article Title: | Quantification of accumulated dose and associated anatomical changes of esophagus using weekly Magnetic Resonance Imaging acquired during radiotherapy of locally advanced lung cancer |
| Abstract: | Background and purpose: Minimizing acute esophagitis (AE) in locally advanced non-small cell lung cancer (LA-NSCLC) is critical given the proximity between the esophagus and the tumor. In this pilot study, we developed a clinical platform for quantification of accumulated doses and volumetric changes of esophagus via weekly Magnetic Resonance Imaging (MRI) for adaptive radiotherapy (RT). Material and methods: Eleven patients treated via intensity-modulated RT to 60–70 Gy in 2–3 Gy-fractions with concurrent chemotherapy underwent weekly MRIs. Eight patients developed AE grade 2 (AE2), 3–6 weeks after RT started. First, weekly MRI esophagus contours were rigidly propagated to planning CT and the distances between the medial esophageal axes were calculated as positional uncertainties. Then, the weekly MRI were deformably registered to the planning CT and the total dose delivered to esophagus was accumulated. Weekly Maximum Esophagus Expansion (MEex) was calculated using the Jacobian map. Eventually, esophageal dose parameters (Mean Esophagus Dose (MED), V90% and D5cc) between the planned and accumulated dose were compared. Results: Positional esophagus uncertainties were 6.8 ± 1.8 mm across patients. For the entire cohort at the end of RT: the median accumulated MED was significantly higher than the planned dose (24 Gy vs. 21 Gy p = 0.006). The median V90% and D5cc were 12.5 cm3 vs. 11.5 cm3 (p = 0.05) and 61 Gy vs. 60 Gy (p = 0.01), for accumulated and planned dose, respectively. The median MEex was 24% and was significantly associated with AE2 (p = 0.008). Conclusions: MRI is well suited for tracking esophagus volumetric changes and accumulating doses. Longitudinal esophagus expansion could reflect radiation-induced inflammation that may link to AE. © 2020 |
| Keywords: | adult; clinical article; aged; middle aged; intensity modulated radiation therapy; advanced cancer; treatment planning; cancer radiotherapy; radiation dose; nuclear magnetic resonance imaging; antineoplastic agent; esophagitis; cohort analysis; lung cancer; radiation injury; pilot study; radiation dose fractionation; esophagus; mri; chemoradiotherapy; acute disease; image registration; gross tumor volume; non small cell lung cancer; anatomical concepts; dose volume histogram; adaptive radiotherapy; four dimensional computed tomography; human; male; female; priority journal; article; dose accumulation |
| Journal Title: | Physics and Imaging in Radiation Oncology |
| Volume: | 13 |
| ISSN: | 2405-6316 |
| Publisher: | Elsevier B.V. |
| Date Published: | 2020-01-01 |
| Start Page: | 36 |
| End Page: | 43 |
| Language: | English |
| DOI: | 10.1016/j.phro.2020.03.002 |
| PROVIDER: | scopus |
| PMCID: | PMC7224352 |
| PUBMED: | 32411833 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 May 2020 -- Source: Scopus |
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