title: Functional image-guided radiotherapy planning in respiratory-gated intensity-modulated radiotherapy for lung cancer patients with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To investigate the incorporation of functional lung image-derived low attenuation area (LAA) based on four-dimensional computed tomography (4D-CT) into respiratory-gated intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) in treatment planning for lung cancer patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Eight lung cancer patients with COPD were the subjects of this study. LAA was generated from 4D-CT data sets according to CT values of less than than -860 Hounsfield units (HU) as a threshold. The functional lung image was defined as the area where LAA was excluded from the image of the total lung. Two respiratory-gated radiotherapy plans (70 Gy/35 fractions) were designed and compared in each patient as follows: Plan A was an anatomical IMRT or VMAT plan based on the total lung; Plan F was a functional IMRT or VMAT plan based on the functional lung. Dosimetric parameters (percentage of total lung volume irradiated with ≥20 Gy [V20], and mean dose of total lung [MLD]) of the two plans were compared.
  
  
  RESULTS
  V20 was lower in Plan F than in Plan A (mean 1.5%, p = 0.025 in IMRT, mean 1.6%, p = 0.044 in VMAT) achieved by a reduction in MLD (mean 0.23 Gy, p = 0.083 in IMRT, mean 0.5 Gy, p = 0.042 in VMAT). No differences were noted in target volume coverage and organ-at-risk doses.
  
  
  CONCLUSIONS
  Functional IGRT planning based on LAA in respiratory-guided IMRT or VMAT appears to be effective in preserving a functional lung in lung cancer patients with COPD.
authors.affiliation: Department of Radiation Oncology, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima City, Japan. tkkimura@hiroshima-u.ac.jp
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kimura
authors.forename: Ikuno
authors.initials: I
authors.lastname: Nishibuchi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Murakami
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kenjo
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kaneyasu
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nagata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus / Q000000981:diagnostic imaging; D056973:Four-Dimensional Computed Tomography / Q000379:methods; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000528:radiation effects; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000000981:diagnostic imaging; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000000981:diagnostic imaging*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D055425:Respiratory-Gated Imaging Techniques / Q000379:methods*; D013116:Spinal Cord / Q000000981:diagnostic imaging