Incidence and evolution of imaging changes on cone-beam CT during and after radical radiotherapy for non-small cell lung cancer

Clarke, Enrico, Curtis, John and Brada, Michael (2019) Incidence and evolution of imaging changes on cone-beam CT during and after radical radiotherapy for non-small cell lung cancer. Radiotherapy and Oncology, 132. pp. 121-126.

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Abstract

<h4>Background and purpose</h4>Cone beam CT (CBCT) is used to improve accuracy of radical radiotherapy by adjusting treatment to the observed imaging changes. To ensure appropriate adjustment, image interpretation should precede any changes to treatment delivery. This study provides the methodology for image interpretation and the frequency and evolution of the changes in patients undergoing radical radiotherapy for localised and locally advanced non-small cell lung cancer (NSCLC).<h4>Patients and methods</h4>From December 2012 to December 2014, 250 patients with localised and locally advanced NSCLC had 2462 chest CBCT scans during the course of fractionated radical radiotherapy (RT) (3-5 daily CBCTs in the first week followed by at least weekly imaging, mean 9.5 per patient, range 1-21). All CBCT images were reviewed describing changes and their evolution using diagnostic imaging definitions and validated by an independent chest radiologist.<h4>Results</h4>During radical RT for NSCLC 328 imaging changes were identified on CBCT in 180 (72%) patients; 104 (32%) had reduction and 41 (13%) increase in tumour size; 48 (15%) had changes in consolidations contiguous to the primary lesion, 26 (8%) non-contiguous consolidations, 43 (13%) changes in tumour cavitation, 36 (11%) pleural effusion and 30 (9%) changes in atelectasis. In 105 patients imaging changes were noted in continuity with the treated tumour of which only 41 (39%) represented tumour enlargement; others included new or enlarging adjacent consolidation (34%), and new or enlarging atelectasis (19%). The changes evolved during treatment.<h4>Conclusion</h4>Imaging changes on CBCT include real and apparent changes in tumour size and parenchymal changes which evolve during treatment. Correct image interpretation, particularly when occurring adjacent to the tumour, is essential prior to adjustment to treatment delivery.

Item Type:	Article
Uncontrolled Keywords:	NSCLC, Radiotherapy, CBCT, IGRT, Imaging, Lung cancer, Cone beam
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Clinical Directorate
Depositing User:	Symplectic Admin
Date Deposited:	04 May 2022 09:00
Last Modified:	24 Jan 2024 21:09
DOI:	10.1016/j.radonc.2018.12.009
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3154265

Available Versions of this Item

• Incidence and evolution of imaging changes on cone-beam CT during and after radical radiotherapy for non-small cell lung cancer. (deposited 15 Jan 2019 11:08)
  • Incidence and evolution of imaging changes on cone-beam CT during and after radical radiotherapy for non-small cell lung cancer. (deposited 04 May 2022 09:00) [Currently Displayed]