Patient-Reported Outcomes: Comparing Functional Avoidance and Standard Thoracic Radiation Therapy in Lung Cancer.

Area of Science:

• Radiation oncology
• Medical imaging
• Clinical trial methodology

Background:

• Four-dimensional computed tomography (4DCT) ventilation imaging offers novel methods for functional imaging.
• Functional avoidance strategies aim to reduce radiation dose to healthy lung tissue.
• Patient-reported outcomes (PROs) are crucial for evaluating treatment effectiveness.

Purpose of the Study:

• To implement 4DCT-ventilation in a phase II clinical trial for functional avoidance in lung cancer.
• To compare PROs from functional avoidance treatment against historical control data.
• To assess the impact of functional avoidance on patient quality of life.

Main Methods:

• Patients with locally advanced lung cancer received curative-intent chemoradiation.
• 4DCT-ventilation imaging guided the creation of functional avoidance treatment plans.
• PROs were collected using FACT-L, EQ-5D, and EQ-VAS, and compared to RTOG 0617 and PACIFIC trial data.

Main Results:

• Forty-seven percent of patients in the RTOG 0617 trial experienced meaningful decline in FACT-TOI versus 26.8% in the functional avoidance group (P=.03).
• The functional avoidance cohort showed a significantly higher change in EQ-VAS scores at 12 months (9.9 ± 3.3) compared to the PACIFIC cohort (1.6 ± 0.6; P=.012).
• Fifty-nine patients completed baseline PRO surveys, with a median age of 65 and 83% diagnosed with non-small cell lung cancer.

Conclusions:

• Phase II functional avoidance using 4DCT-ventilation demonstrated improved PROs in specific subscales (FACT-TOI, EQ-VAS).
• These findings suggest that 4DCT functional avoidance is a promising strategy for lung cancer treatment.
• Further investigation in a phase III setting is warranted to confirm these improved patient outcomes.