Estimation of overall pulmonary function after irradiation using dose-effect relations for local functional injury.

PURPOSE To predict the pulmonary function 3-4 months after irradiation for malignant lymphoma from the three-dimensional (3-D) dose distribution. METHODS Dose-effect relations for the relative reduction of local perfusion (Q) and local ventilation (V), were calculated in 25 patients, using correlated SPECT (Single Photon Emission Computed Tomography) and CT data. By combining the 3-D dose distribution of an individual patient with the dose-effect relations averaged over all patients, the average reduction of local Q and V (i.e., the overall response parameters) in the whole lung was estimated for each patient. Correlation coefficients were calculated between these overall response parameters and the change in standard lung function tests. In addition, the relation between the overall response parameters and the incidence of radiation pneumonitis was determined. RESULTS The overall response parameter for perfusion was correlated with the change in standard lung function tests, with correlation coefficients varying between 0.53 (p = 0.007) and 0.71 (p < 0.001) for the change of Vital Capacity and Forced Expiratory Volume at 1 s, respectively. For the overall response parameter for ventilation similar correlations were observed. Four out of the 25 patients developed radiation pneumonitis; in these four patients the overall response parameter for perfusion was on average somewhat higher (13.2 +/- 1.4% (1 standard error of the mean)) than in patients without radiation pneumonitis (10.5 +/- 1.0%), but this difference was not significant. A higher incidence of radiation pneumonitis was observed for larger values of the overall response parameter for perfusion; in patient groups with an overall response parameter for perfusion of 0-5%, 5-10%, 10-15%, and 15-20%, the incidence of radiation pneumonitis was 0 (0/1), 10 (1/10), 13 (1/8) and 33% (2/6), respectively. CONCLUSION By combining the 3-D dose distribution with the average dose-effect relations for local perfusion or ventilation, an overall response parameter can be calculated prior to irradiation, which is predictive for the radiation-induced change in the overall pulmonary function, and possibly for the incidence of radiation pneumonitis, in this group of patients.

[1]  N. Gross Pulmonary effects of radiation therapy. , 1977, Annals of internal medicine.

[2]  J E Cotes,et al.  Lung volumes and forced ventilatory flows , 1993, European Respiratory Journal.

[3]  N. Choi,et al.  Effect of postoperative radiotherapy on changes in pulmonary function in patients with stage II and IIIA lung carcinoma. , 1990, International journal of radiation oncology, biology, physics.

[4]  W. Bria,et al.  Prediction of postoperative pulmonary function following thoracic operations. Value of ventilation-perfusion scanning. , 1983, The Journal of thoracic and cardiovascular surgery.

[5]  L. Solin,et al.  Prospective prediction of post-radiation therapy lung function using quantitative lung scans and pulmonary function testing. , 1988, International journal of radiation oncology, biology, physics.

[6]  M. Goitein,et al.  Tolerance of normal tissue to therapeutic irradiation. , 1991, International journal of radiation oncology, biology, physics.

[7]  G J Kutcher,et al.  Probability of radiation-induced complications for normal tissues with parallel architecture subject to non-uniform irradiation. , 1993, Medical physics.

[8]  N. van Zandwijk,et al.  Lung volume calculations from 81Krm SPECT for the quantification of regional ventilation. , 1988, Clinical physics and physiological measurement : an official journal of the Hospital Physicists' Association, Deutsche Gesellschaft fur Medizinische Physik and the European Federation of Organisations for Medical Physics.

[9]  J. Van Dyk,et al.  Evaluation of isoeffect formulae for predicting radiation-induced lung damage. , 1993, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[10]  C K Wells,et al.  Evaluation of clinical methods for rating dyspnea. , 1988, Chest.

[11]  J. Fowler Radiation-induced lung damage: dose-time fractionation considerations. , 1990, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[12]  R. Forster,et al.  A standardized breath holding technique for the clinical measurement of the diffusing capacity of the lung for carbon monoxide. , 1957, The Journal of clinical investigation.

[13]  L. Boersma,et al.  Dose-effect relations for local functional and structural changes of the lung after irradiation for malignant lymphoma. , 1994, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[14]  G J Kutcher,et al.  Probability of radiation-induced complications in normal tissues with parallel architecture under conditions of uniform whole or partial organ irradiation. , 1993, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[15]  W. Curran,et al.  Observations on the predictive value of perfusion lung scans on post-irradiation pulmonary function among 210 patients with bronchogenic carcinoma. , 1992, International journal of radiation oncology, biology, physics.

[16]  J. Horiot,et al.  A glossary for reporting complications of treatment in gynecological cancers. , 1993, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[17]  A. Niemierko,et al.  Modeling of normal tissue response to radiation: the critical volume model. , 1993, International journal of radiation oncology, biology, physics.

[18]  Denis E. O'Donnell,et al.  Clinical Respiratory Physiology , 2019, Clinics in Chest Medicine.

[19]  J. Smith,et al.  Lung cancer in patients with borderline lung functions--zonal lung perfusion scans at presentation and lung function after high dose irradiation. , 1990, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[20]  P. Kirchner,et al.  Clinical value of quantitative ventilation-perfusion lung scans in the surgical management of bronchogenic carcinoma. , 1980, The Journal of thoracic and cardiovascular surgery.

[21]  R K Ten Haken,et al.  Dose-volume histogram and 3-D treatment planning evaluation of patients with pneumonitis. , 1994, International journal of radiation oncology, biology, physics.

[22]  R W de Boer,et al.  Quantifying local lung perfusion and ventilation using correlated SPECT and CT data. , 1994, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[23]  R W de Boer,et al.  A new method to determine dose-effect relations for local lung-function changes using correlated SPECT and CT data. , 1993, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.