Comparing the outcomes of MR-based versus CT-based tumor delineation in locally advanced non-small cell lung cancer treated with hypo-fractionated radiotherapy and concurrent chemotherapy.

IF 4 2区 医学 Q2 ONCOLOGY Translational lung cancer research Pub Date : 2024-11-30 Epub Date: 2024-11-06 DOI:10.21037/tlcr-24-341
Pengxin Zhang, Shouliang Ding, Kangqiang Peng, Haoqiang He, Daquan Wang, Rui Zhou, Bin Wang, Jinyu Guo, Hongdong Liu, Xiaoyan Huang, Chuanmiao Xie, Hui Liu, Bo Qiu
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Abstract

Background: Delineating gross tumor volume (GTV) using computed tomography (CT) imaging is the standard for lung cancer contouring, but discrepancies among observers compromise accuracy and reliability. Magnetic resonance imaging (MRI) provides superior soft-tissue resolution compared to CT, thus, we design this retrospective study to compare the treatment outcomes of magnetic resonance-based (MR-based) and CT-based tumor delineation in locally advanced non-small cell lung cancer (LA-NSCLC) patients treated with hypo-fractionated concurrent chemoradiotherapy (hypo-CCRT).

Methods: A total of 293 LA-NSCLC patients treated with hypo-CCRT from three trials between October 2015 and October 2020 were screened. Ninety patients with each MR-based delineation and CT-based delineation of the primary tumor were selected for analysis. In the MR-based delineation group, T1-enhanced MR images was rigidly registered with 10 respiratory phases of planning CT images, respectively. The primary tumors were contoured on each respiratory phase based on co-registered MRI. The locoregional progression-free survival (LPFS), progression-free survival (PFS), overall survival (OS) and toxicities in both groups were analyzed.

Results: The 2-year LPFS rate was 69.2% [95% confidence interval (CI): 59.6-80.2%] in the MR-based delineation group and 61.0% (95% CI: 50.9-73.0%) in the CT-based delineation group (P=0.37). There was no significant difference in median PFS (P=0.45) or OS (P=0.69) between the two groups. The MR-based delineation group had smaller planning target volume (186.1 vs. 315.3 cm3, P<0.001), lower incidences of ≥G2 pneumonitis (10% vs. 24.4%, P=0.001) and ≥G3 esophagitis (2.2% vs. 15.6%, P<0.001). In evaluating the patterns of recurrence, in-field recurrences were the dominant type in both groups (21 out of 27 patients in MR-based delineation group, 24 out of 32 patients in CT-based delineation group).

Conclusions: MR-based delineation in hypo-CCRT was feasible and achieved similar treatment efficacy to CT-based delineation. The use of MR imaging to reduce the target volume resulted in promising local control and lower incidence of radiation-induced toxicities.

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在局部晚期非小细胞肺癌患者接受低分次放疗和同期化疗时,比较基于磁共振和基于 CT 的肿瘤划分结果。
背景:使用计算机断层扫描(CT)成像描绘肿瘤总体积(GTV)是肺癌轮廓的标准,但观察者之间的差异损害了准确性和可靠性。与CT相比,磁共振成像(MRI)提供了更好的软组织分辨率,因此,我们设计了这项回顾性研究,以比较基于磁共振(mr)和基于CT的局部晚期非小细胞肺癌(LA-NSCLC)患者接受低分级并行放化疗(hypo-CCRT)治疗的治疗结果。方法:对2015年10月至2020年10月期间接受低ccrt治疗的293例LA-NSCLC患者进行筛查。分别对原发肿瘤进行mri和ct描述的90例患者进行分析。在基于MR的圈定组中,t1增强MR图像分别与规划CT图像的10个呼吸期严格配准。在共登记MRI的基础上,在每个呼吸期绘制原发肿瘤的轮廓。分析两组患者的局部无进展生存期(LPFS)、无进展生存期(PFS)、总生存期(OS)及毒副反应。结果:基于mri的划定组2年LPFS率为69.2%[95%可信区间(CI): 59.6-80.2%],基于ct的划定组为61.0% (95% CI: 50.9-73.0%) (P=0.37)。两组间的中位PFS (P=0.45)和OS (P=0.69)无显著差异。基于mr的划定组计划靶体积较小(186.1 vs. 315.3 cm3, vs. 24.4%, P=0.001),≥G3级食管炎(2.2% vs. 15.6%, P)。结论:基于mr的划定在低ccrt中是可行的,其治疗效果与基于ct的划定相似。使用磁共振成像来缩小靶体积导致有希望的局部控制和降低辐射引起的毒性的发生率。
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来源期刊
CiteScore
7.20
自引率
2.50%
发文量
137
期刊介绍: Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.
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