Feasibility of treatment planning for 4D-CT high ventilation functional lung avoided radiotherapy in thoracic cancer
Objective To establish a radiotherapy treatment planning process of high ventilation functional lung avoided(HVFLA)for thoracic tumors based on 4D-CT lung ventilation functional images and determine the treatment planning strategy of HVFLA radiotherapy,and so as to provide support for the clinical trials of HVFLA radiotherapy in thoracic cancer patients.Methods A deep learning-based 4D-CT lung ventilation functional imaging model was established and integrated into the radiotherapy treatment planning process.Furthermore,ten thoracic cancer patients with 4D-CT simulation positioning were retrospectively enrolled in this study.The established model was used to obtain the 4D-CT lung ventilation functional imaging for each patient.According to the relative value of lung ventilation,the lung ventilation areas are equally segmented into high,medium and low lung ventilation and then imported them into Pinnacle3 treatment planning system.According to the prescription dose of target and dose constraints of organ at risks(OARs),the clinical and HVFLA treatment plans were designed for each patient using volumetric modulated radiotherapy technique,and each plan should meet the clinical requirements and adding dose constraints of high ventilation functional lung for HVFLA plan.The dosimetric indexes of the target,OARs(lungs,heart and cord)and high functional lung(HFL)were used to evaluated the plan quality.The dosimetric indexes included D2,D98 and mean dose of target,V5,V10,V20,V30 and mean dose of lungs and HFL,V30,V40 and mean dose of heart,and D1cm3 of cord.Paired samples t-test was used for statistical analysis of the two groups of plans.Results The target and OARs of the clinical plan and HVFLA plan meet the clinical requirements.The HVFLA plan resulted in a statistically significant reduction in the mean dose,V5,V10,V20,and V30 of the high functional lung by 1.2 Gy,5.9％,4.2％,2.6％,and 2.3％,respectively(t=-8.07,4.02,-6.02,-7.06,-6.77,P＜0.05).There was no statistical difference in the dosimetric indexes of lungs,heart and cord.Conclusions We established the treatment planning process of HVFLA radiotherapy based on 4D-CT lung ventilation functional images.The HVFLA plan can effectively reduce the dose of HFL,while the doses of lungs,heart and cord had no significant difference compared with the clinical plan.The strategy of HVFLA radiotherapy planning is feasible to provide support for the implementation of HVFLA radiotherapy in thoracic cancer patients.
4D-CT lung ventilation functionLung function avoidedRadiotherapy treatment planningDeep learning
NETL
NSTL
万方数据
