title: New techniques for assessing response after hypofractionated radiotherapy for lung cancer.
abstract: Hypofractionated radiotherapy (HFRT) is an effective and increasingly-used treatment for early stage non-small cell lung cancer (NSCLC). Stereotactic ablative radiotherapy (SABR) is a form of HFRT and delivers biologically effective doses (BEDs) in excess of 100 Gy10 in 3-8 fractions. Excellent long-term outcomes have been reported; however, response assessment following SABR is complicated as radiation induced lung injury can appear similar to a recurring tumor on CT. Current approaches to scoring treatment responses include Response Evaluation Criteria in Solid Tumors (RECIST) and positron emission tomography (PET), both of which appear to have a limited role in detecting recurrences following SABR. Novel approaches to assess response are required, but new techniques should be easily standardized across centers, cost effective, with sensitivity and specificity that improves on current CT and PET approaches. This review examines potential novel approaches, focusing on the emerging field of quantitative image feature analysis, to distinguish recurrence from fibrosis after SABR.
authors.affiliation: 1 Department of Medical Biophysics, 2 Department of Oncology, The University of Western Ontario, London, ON, Canada ; 3 Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada ; 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Mattonen
authors.affiliation: 1 Department of Medical Biophysics, 2 Department of Oncology, The University of Western Ontario, London, ON, Canada ; 3 Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada ; 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Kitty
authors.initials: K
authors.lastname: Huang
authors.affiliation: 1 Department of Medical Biophysics, 2 Department of Oncology, The University of Western Ontario, London, ON, Canada ; 3 Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada ; 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Ward
authors.affiliation: 1 Department of Medical Biophysics, 2 Department of Oncology, The University of Western Ontario, London, ON, Canada ; 3 Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada ; 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Suresh
authors.initials: S
authors.lastname: Senan
authors.affiliation: 1 Department of Medical Biophysics, 2 Department of Oncology, The University of Western Ontario, London, ON, Canada ; 3 Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada ; 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: David A
authors.initials: DA
authors.lastname: Palma
keywords: Lung cancer; hypofractionated radiotherapy (HFRT); image feature analysis; positron emission tomography (PET); stereotactic radiotherapy