Daily Image Guidance With Cone Beam Computed Tomography May Reduce Radiation Pneumonitis in Unresectable Non-Small Cell Lung Cancer

Nikhil Yegya-Raman, Sinae Kim, Matthew P. Deek, Diana Li, Apar Gupta, Laura Bond, Abhishek Dwivedi, Joel K. Braver, Meral Reyhan, Akaash Mittal, Bin Gui, Jyoti Malhotra, Joseph Aisner, Salma Jabbour

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To investigate the impact of daily image-guided radiation therapy technique on clinical outcomes in patients with inoperable non-small cell lung cancer treated with definitive chemoradiation therapy. Methods and Materials: We compared patients with inoperable non-small cell lung cancer receiving daily cone beam computed tomography (CBCT) after an initial 4-dimensional computed tomography (4DCT) simulation (n = 76) with those receiving daily 2-dimensional orthogonal kilovoltage (kV) imaging (n = 48). The primary endpoint was time to grade ≥2 radiation pneumonitis (RP2), estimated with the cumulative incidence method, compared with Gray's test, and modeled with the Fine-Gray method. Results: Median follow-up was 40.6 months (range, 5.9-58.1 months) for the CBCT group and 75.8 months (range, 9.9-107.8 months) for the orthogonal kV group. Four-dimensional computed tomography simulation was used in 100% (n = 76) of the CBCT group and 56% (n = 27) of the orthogonal kV group (P < .0001). The 1-year cumulative incidence of RP2 was lower in the CBCT group than in the orthogonal kV group (24% vs 44%, P = .020). On multivariate analysis, daily imaging with CBCT after an initial 4DCT simulation was associated with a decreased risk of RP2 (adjusted hazard ratio 0.43, 95% confidence interval 0.22-0.82, P = .011), a finding that persisted among only patients who received 4DCT simulation (adjusted hazard ratio 0.48, 95% confidence interval 0.23-0.98, P = .045). There was no difference in locoregional progression, distant metastasis, any progression, or overall survival between groups. Conclusions: Daily image guided radiation therapy with CBCT compared with 2-dimensional orthogonal kV imaging was associated with a decreased risk of RP2. Clinicians could consider the implications of localization methods during curative intent radiation therapy.

Original languageEnglish (US)
Pages (from-to)1104-1112
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume101
Issue number5
DOIs
StatePublished - Aug 1 2018

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Radiation Pneumonitis
Cone-Beam Computed Tomography
Non-Small Cell Lung Carcinoma
lungs
cones
tomography
cancer
radiation
Image-Guided Radiotherapy
Tomography
radiation therapy
Four-Dimensional Computed Tomography
Confidence Intervals
progressions
Incidence
hazards
confidence
simulation
incidence
intervals

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Yegya-Raman, Nikhil ; Kim, Sinae ; Deek, Matthew P. ; Li, Diana ; Gupta, Apar ; Bond, Laura ; Dwivedi, Abhishek ; Braver, Joel K. ; Reyhan, Meral ; Mittal, Akaash ; Gui, Bin ; Malhotra, Jyoti ; Aisner, Joseph ; Jabbour, Salma. / Daily Image Guidance With Cone Beam Computed Tomography May Reduce Radiation Pneumonitis in Unresectable Non-Small Cell Lung Cancer. In: International Journal of Radiation Oncology Biology Physics. 2018 ; Vol. 101, No. 5. pp. 1104-1112.
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abstract = "Purpose: To investigate the impact of daily image-guided radiation therapy technique on clinical outcomes in patients with inoperable non-small cell lung cancer treated with definitive chemoradiation therapy. Methods and Materials: We compared patients with inoperable non-small cell lung cancer receiving daily cone beam computed tomography (CBCT) after an initial 4-dimensional computed tomography (4DCT) simulation (n = 76) with those receiving daily 2-dimensional orthogonal kilovoltage (kV) imaging (n = 48). The primary endpoint was time to grade ≥2 radiation pneumonitis (RP2), estimated with the cumulative incidence method, compared with Gray's test, and modeled with the Fine-Gray method. Results: Median follow-up was 40.6 months (range, 5.9-58.1 months) for the CBCT group and 75.8 months (range, 9.9-107.8 months) for the orthogonal kV group. Four-dimensional computed tomography simulation was used in 100{\%} (n = 76) of the CBCT group and 56{\%} (n = 27) of the orthogonal kV group (P < .0001). The 1-year cumulative incidence of RP2 was lower in the CBCT group than in the orthogonal kV group (24{\%} vs 44{\%}, P = .020). On multivariate analysis, daily imaging with CBCT after an initial 4DCT simulation was associated with a decreased risk of RP2 (adjusted hazard ratio 0.43, 95{\%} confidence interval 0.22-0.82, P = .011), a finding that persisted among only patients who received 4DCT simulation (adjusted hazard ratio 0.48, 95{\%} confidence interval 0.23-0.98, P = .045). There was no difference in locoregional progression, distant metastasis, any progression, or overall survival between groups. Conclusions: Daily image guided radiation therapy with CBCT compared with 2-dimensional orthogonal kV imaging was associated with a decreased risk of RP2. Clinicians could consider the implications of localization methods during curative intent radiation therapy.",
author = "Nikhil Yegya-Raman and Sinae Kim and Deek, {Matthew P.} and Diana Li and Apar Gupta and Laura Bond and Abhishek Dwivedi and Braver, {Joel K.} and Meral Reyhan and Akaash Mittal and Bin Gui and Jyoti Malhotra and Joseph Aisner and Salma Jabbour",
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Daily Image Guidance With Cone Beam Computed Tomography May Reduce Radiation Pneumonitis in Unresectable Non-Small Cell Lung Cancer. / Yegya-Raman, Nikhil; Kim, Sinae; Deek, Matthew P.; Li, Diana; Gupta, Apar; Bond, Laura; Dwivedi, Abhishek; Braver, Joel K.; Reyhan, Meral; Mittal, Akaash; Gui, Bin; Malhotra, Jyoti; Aisner, Joseph; Jabbour, Salma.

In: International Journal of Radiation Oncology Biology Physics, Vol. 101, No. 5, 01.08.2018, p. 1104-1112.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Daily Image Guidance With Cone Beam Computed Tomography May Reduce Radiation Pneumonitis in Unresectable Non-Small Cell Lung Cancer

AU - Yegya-Raman, Nikhil

AU - Kim, Sinae

AU - Deek, Matthew P.

AU - Li, Diana

AU - Gupta, Apar

AU - Bond, Laura

AU - Dwivedi, Abhishek

AU - Braver, Joel K.

AU - Reyhan, Meral

AU - Mittal, Akaash

AU - Gui, Bin

AU - Malhotra, Jyoti

AU - Aisner, Joseph

AU - Jabbour, Salma

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Purpose: To investigate the impact of daily image-guided radiation therapy technique on clinical outcomes in patients with inoperable non-small cell lung cancer treated with definitive chemoradiation therapy. Methods and Materials: We compared patients with inoperable non-small cell lung cancer receiving daily cone beam computed tomography (CBCT) after an initial 4-dimensional computed tomography (4DCT) simulation (n = 76) with those receiving daily 2-dimensional orthogonal kilovoltage (kV) imaging (n = 48). The primary endpoint was time to grade ≥2 radiation pneumonitis (RP2), estimated with the cumulative incidence method, compared with Gray's test, and modeled with the Fine-Gray method. Results: Median follow-up was 40.6 months (range, 5.9-58.1 months) for the CBCT group and 75.8 months (range, 9.9-107.8 months) for the orthogonal kV group. Four-dimensional computed tomography simulation was used in 100% (n = 76) of the CBCT group and 56% (n = 27) of the orthogonal kV group (P < .0001). The 1-year cumulative incidence of RP2 was lower in the CBCT group than in the orthogonal kV group (24% vs 44%, P = .020). On multivariate analysis, daily imaging with CBCT after an initial 4DCT simulation was associated with a decreased risk of RP2 (adjusted hazard ratio 0.43, 95% confidence interval 0.22-0.82, P = .011), a finding that persisted among only patients who received 4DCT simulation (adjusted hazard ratio 0.48, 95% confidence interval 0.23-0.98, P = .045). There was no difference in locoregional progression, distant metastasis, any progression, or overall survival between groups. Conclusions: Daily image guided radiation therapy with CBCT compared with 2-dimensional orthogonal kV imaging was associated with a decreased risk of RP2. Clinicians could consider the implications of localization methods during curative intent radiation therapy.

AB - Purpose: To investigate the impact of daily image-guided radiation therapy technique on clinical outcomes in patients with inoperable non-small cell lung cancer treated with definitive chemoradiation therapy. Methods and Materials: We compared patients with inoperable non-small cell lung cancer receiving daily cone beam computed tomography (CBCT) after an initial 4-dimensional computed tomography (4DCT) simulation (n = 76) with those receiving daily 2-dimensional orthogonal kilovoltage (kV) imaging (n = 48). The primary endpoint was time to grade ≥2 radiation pneumonitis (RP2), estimated with the cumulative incidence method, compared with Gray's test, and modeled with the Fine-Gray method. Results: Median follow-up was 40.6 months (range, 5.9-58.1 months) for the CBCT group and 75.8 months (range, 9.9-107.8 months) for the orthogonal kV group. Four-dimensional computed tomography simulation was used in 100% (n = 76) of the CBCT group and 56% (n = 27) of the orthogonal kV group (P < .0001). The 1-year cumulative incidence of RP2 was lower in the CBCT group than in the orthogonal kV group (24% vs 44%, P = .020). On multivariate analysis, daily imaging with CBCT after an initial 4DCT simulation was associated with a decreased risk of RP2 (adjusted hazard ratio 0.43, 95% confidence interval 0.22-0.82, P = .011), a finding that persisted among only patients who received 4DCT simulation (adjusted hazard ratio 0.48, 95% confidence interval 0.23-0.98, P = .045). There was no difference in locoregional progression, distant metastasis, any progression, or overall survival between groups. Conclusions: Daily image guided radiation therapy with CBCT compared with 2-dimensional orthogonal kV imaging was associated with a decreased risk of RP2. Clinicians could consider the implications of localization methods during curative intent radiation therapy.

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