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. 2023 Mar 11;15(6):1726.
doi: 10.3390/cancers15061726.

A Feasibility Study of Functional Lung Volume Preservation during Stereotactic Body Radiotherapy Guided by Gallium-68 Perfusion PET/CT

François Lucia  1   2 , Mohamed Hamya  1 , Fanny Pinot  3 , Gaëlle Goasduff  1 , Frédérique Blanc-Béguin  3   4 , David Bourhis  3   4 , Olivier Pradier  1   2 , Anne-Sophie Lucia  1 , Simon Hennebicq  3   4 , Maëlle Mauguen  1 , Romain Floch  3 , Ulrike Schick  1   2 , Vincent Bourbonne  1   2 , Pierre-Yves Salaün  3   4 , Pierre-Yves Le Roux  3   4
Affiliations

A Feasibility Study of Functional Lung Volume Preservation during Stereotactic Body Radiotherapy Guided by Gallium-68 Perfusion PET/CT

François Lucia et al. Cancers (Basel). .

Abstract

The aim of this study was to assess the feasibility of sparing functional lung areas by integration of pulmonary functional mapping guided by 68Ga-perfusion PET/CT imaging in lung SBRT planification. Sixty patients that planned to receive SBRT for primary or secondary lung tumors were prospectively enrolled. Lung functional volumes were defined as the minimal volume containing 50% (FV50%), 70% (FV70%) and 90% (FV90%) of the total activity within the anatomical volume. All patients had a treatment planning carried out in 2 stages: an anatomical planning blinded to the PET results and then a functional planning respecting the standard constraints but also incorporating "lung functional volume" constraints. The mean lung dose (MLD) in functional volumes and the percentage of lung volumes receiving xGy (VxGy) within the lung functional volumes using both plans were calculated and compared. SBRT planning optimized to spare lung functional regions led to a significant reduction (p < 0.0001) of the MLD and V5 to V20 Gy in all functional volumes. Median relative difference of the MLD in the FV50%, FV70% and FV90% was -8.0% (-43.0 to 1.2%), -7.1% (-34.3 to 1.2%) and -5.7% (-22.3 to 4.4%), respectively. Median relative differences for VxGy ranged from -12.5% to -9.2% in the FV50%, -11.3% to -7.2% in the FV70% and -8.0% to -5.3% in the FV90%. This study shows the feasibility of significantly decreasing the doses delivered to the lung functional volumes using 68Ga-perfusion PET/CT while still respecting target volume coverage and doses to other organs at risk.

Keywords: Gallium-68 perfusion PET/CT; lung cancer; stereotactic body radiation therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Example of anatomic volume (AV) (at the left) and lung functional volumes (FV) delineation. The FV90% (in blue), FV70% (in green) and FV50% (in red) volumes were defined as the minimal volume containing 90% (FV90%), 70% (FV70%) and 50% (FV50%) of the total activity within the AV.
Figure 2
Figure 2
Distribution of absolute difference (A) and relative difference (B) of the mean lung dose (MLD) and relative difference for the V5Gy (C) between anatomical planning and functional planning in the FV50% lung functional volume.
Figure 2
Figure 2
Distribution of absolute difference (A) and relative difference (B) of the mean lung dose (MLD) and relative difference for the V5Gy (C) between anatomical planning and functional planning in the FV50% lung functional volume.
Figure 3
Figure 3
Example of personalized lung SBRT planning and dosimetry based on 68Ga-perfusion PET/CT imaging. The first row shows the conventional anatomical planning based on CT imaging. The second row shows functional planning based on 68Ga-perfusion PET/CT imaging. The anatomical planning included highly functional lung volumes in the left upper lobe. By incorporating an additional “functional lung volume constraint” to the lung FV50% in addition to the standard constraints in SBRT planning, it was possible to spare this highly functional volume in the left upper lobe, to the detriment of the posterior aspect of the right upper lobe which was non-functional. This resulted in a 38% decrease of the dose in the FV50% volume and a 76% decrease of the FV50% volume receiving more than 5Gy.
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