Development of heart-sparing VMAT radiotherapy technique incorporating heart substructures for advanced NSCLC patients.

IF 3.3 2区医学 Q2 ONCOLOGY Radiation Oncology Pub Date : 2025-03-14 DOI:10.1186/s13014-025-02597-9

Linda Agolli, Ann-Katrin Exeli, Uwe Schneider, Sandra Michaela Ihne-Schubert, Andreas Lurtz, Daniel Habermehl

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引用次数: 0

Abstract

Objective: To investigate the feasibility of active heart sparing (AHS) planning in patients with locally advanced and centrally located NSCLC receiving standard definitive radiotherapy (RT), while maintaining or improving appropriate lung, esophagus, and spinal cord constraints and planning target volume (PTV) coverage intent.

Methods and materials: A total of 27 patients with stage IIIA/B NSCLC treated with curative intent RT were selected for this analysis. All existing radiation plans were revised and 27 further new equivalent plans were calculated using AHS for the same cohort of patients. Primary end-point was feasibility of AHS using constraints for heart substructures. The secondary end point was to calculate the difference in terms of dosimetric parameters of heart substructures and principal OARs as well as PTV-coverage parameters within the current patient group.

Results: AHS was feasible in the entire group of patients. An optimal coverage of the target volume was obtained and all mandatory constraints for OARs have been met. The median value of the mean heart dose (MHD) was 8.18 Gy and 6.71 Gy in the standard planning group and AHS-group, respectively (p = 0.000). Other heart parameters such as V_5Gy (40.57% vs. 27.7%; p = 0.000) and V_30Gy (5.39% vs. 3.86%; p = 0.000) were significantly worse in the standard planning group. The following relevant dosimetric parameters regarding heart substructures were found to be significantly worse in the standard planning group compared to the AHS-group: median dose to heart base (16.97 Gy vs. 6.37 Gy, p = 0.000), maximum dose (18.64 Gy vs. 6.05 Gy, p = 0.000) and V_15Gy (11.11% vs. 0% p = 0.000) to LAD; mean dose; V_5Gy (9.55% vs. 0.94%, p = 0.000) and V_23Gy (0.00% vs. 0.00% maximum 45.68% vs. 6.57%, p = 0.002 to the left ventricle.

Conclusion: Our analysis showed an improvement of dosimetric parameters of the heart and heart substructures in patients affected by locally advanced and centrally located NSCLC treated with curative RT using AHS optimization. This approach could lead to a possible reduction of heart events and a prolonged survival. New clinical studies regarding RT in advanced NSCLC should include cardiologic evaluations and biomarkers as well as the contouring of cardiac substructures.

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目的研究在接受标准确定性放疗（RT）的局部晚期和中心位置NSCLC患者中进行主动心脏疏通（AHS）计划的可行性，同时保持或改善适当的肺、食管和脊髓约束以及计划靶体积（PTV）覆盖意图：本次分析共选择了 27 名接受根治性 RT 治疗的 IIIA/B 期 NSCLC 患者。对所有现有的放射计划进行了修订，并对同一批患者使用 AHS 计算了 27 个新的等效计划。主要终点是使用心脏亚结构约束的 AHS 的可行性。次要终点是计算当前患者群中心脏亚结构和主要 OAR 的剂量学参数以及 PTV 覆盖参数的差异：整组患者均可接受 AHS 治疗。结果：AHS 对整组患者都是可行的，获得了最佳的靶区覆盖率，并满足了所有 OAR 的强制性约束条件。标准计划组和 AHS 组的平均心脏剂量 (MHD) 中值分别为 8.18 Gy 和 6.71 Gy（p = 0.000）。其他心脏参数，如 V5Gy (40.57% vs. 27.7%; p = 0.000) 和 V30Gy (5.39% vs. 3.86%; p = 0.000)，在标准计划组明显更差。与 AHS 组相比，标准计划组在心脏下结构方面的以下相关剂量学参数明显较差：心脏底部的中位剂量（16.97 Gy vs. 6.37 Gy，p = 0.000）、最大剂量（18.64 Gy vs. 6.05 Gy，p = 0.000）和V15Gy（11.11% vs. 0% p = 0.000）到左心室；平均剂量；V5Gy（9.55% vs. 0.94%，p = 0.000）和V23Gy（0.00% vs. 0.00%，最大值45.68% vs. 6.57%，p = 0.002）到左心室：我们的分析表明，对于接受根治性 RT 治疗的局部晚期和中央型 NSCLC 患者，使用 AHS 优化技术可改善心脏和心脏下结构的剂量参数。这种方法可能会减少心脏事件，延长生存期。有关晚期 NSCLC RT 的新临床研究应包括心脏病学评估和生物标志物以及心脏亚结构轮廓。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiation Oncology ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

6.50

自引率

2.80%

发文量

181

审稿时长

3-6 weeks

期刊介绍： Radiation Oncology encompasses all aspects of research that impacts on the treatment of cancer using radiation. It publishes findings in molecular and cellular radiation biology, radiation physics, radiation technology, and clinical oncology.