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Functional Lung Avoidance Planning Using Multicriteria Optimization.

Nicholas Bucknell1, Nicholas Hardcastle2, Lachlan McIntosh3

  • 1Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia.

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This summary is machine-generated.

Multicriteria optimization (MCO) enabled functional lung avoidance (FLA) radiation therapy, sparing functioning lung regions. While MCO adapted plans for FLA, it required clinician oversight for trade-offs in target coverage.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Pulmonary Medicine

Background:

  • Functional lung avoidance (FLA) radiation therapy aims to minimize dose to healthy lung tissue.
  • Multicriteria optimization (MCO) is a planning technique that may facilitate FLA.
  • Accurate identification of functioning lung regions is crucial for effective FLA.

Purpose of the Study:

  • To assess the feasibility of using MCO to adapt radiation therapy plans for FLA.
  • To spare dose to highly functioning lung (HF lung) and functional lung (F lung) regions.
  • To compare plan quality metrics between baseline anatomic and MCO-generated FLA plans.

Main Methods:

  • Prospective clinical trial involving 38 Stage III non-small cell lung cancer patients.
  • Utilized 68Ga-4D-V/Q PET/CT to define functional lung volumes (HF lung and F lung).
  • Generated baseline anatomic plans and MCO-adapted FLA plans, with clinician selection of the final FLA plan.

Main Results:

  • Successful sparing of HF lung in all patients and F lung in 36/38 patients.
  • No significant differences in dose to organs at risk.
  • Statistically significant reduction in mean functional lung dose, with some changes in planning target volume doses.

Conclusions:

  • MCO is a feasible tool for FLA radiation therapy planning.
  • MCO adaptation led to changes in planning target volume coverage, necessitating clinician decision-making.
  • MCO allows real-time evaluation of trade-offs between FLA benefits and target coverage.