Predictive value of vascular calcification identified in 4D planning CT of lung cancer patients treated with stereotactic body radiation therapy |
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| Affiliation: | 1. Division of Cancer Science, University of Manchester, Manchester, UK;2. Radiotherapy Related Research, The Christie Foundation Trust, Manchester, UK;3. Christie Medical Physics & Engineering, The Christie NHS Foundation Trust, Manchester, UK;1. Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD 4029, Australia;2. Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia;1. School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China;2. Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China;3. The Sixth affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China;1. Medical Physics and Radiation Protection Department, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia;2. Medical Physics and Biophysics Department, Medical Faculty, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia;3. Radiology Department, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia;4. Radiology Department, Medical Faculty, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia;5. Radiology Department, General Hospital Pula, Santoriova 24a, Pula, Croatia;6. Department of Medical Physics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy;7. Massachusetts General Hospital, Boston, MA, USA;8. Harvard Medical School, Boston, MA, USA;1. Fondazione IRCCS Policlinico San Matteo Pavia e Università degli Studi di Milano, Italy;2. Fondazione IRCCS Policlinico San Matteo Pavia, Italy;3. Lancashire University teaching Hospitals Preston, UK;1. Guy’s & St Thomas’ Hospitals NHS Trust, London, UK;2. Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK;3. Cancer Research UK & University College London Cancer Trials Centre, London, UK;4. Oxford University Hospital NHS FT, UK;5. MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK;6. University College London, UK;1. Faculty of Health Science, University of Malta, Msida, Malta;2. Faculty of Medicine (AMC), University of Amsterdam, Amsterdam, The Netherlands;3. Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK;4. Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands;5. University of Manchester, Manchester Academic Health Centre, The Christie NHS Foundation Trust, Manchester, UK |
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| Abstract: | PurposeThe aim was to identify vascular calcification in 4DCT scan of lung cancer patients and establish the association between overall survival (OS) and vascular calcification, as surrogate for vascular health.MethodsVascular calcification within the thoracic cavity were segmented in 334 lung cancer patients treated with stereotactic body radiation therapy (SBRT). This has been done automatically on 4D planning CT and average reconstruction scans. Correlation between cardiac comorbidity and calcification volumes was evaluated for patients with recorded Adult Co-Morbidity Evaluation (n = 303). Associations between the identified calcifications and OS were further investigated.ResultsThe volume of calcification from the average scan was significantly lower than from each phase (p < 0.001). The highest level of correlations between cardiac comorbidity and volume of the calcifications were found for one phase representing inhale and two phases representing exhale with the least motion blurring due to respiration (p < 0.005). The volume of the calcifications was subsequently averaged over these three phases. The average of calcification volumes over the three phases (denoted by inhale-exhale) showed the highest likelihood in univariate analysis and was chosen as vascular calcification measure. Cox-model suggested that tumor volume (Hazard Ratio [HR] = 1.46, p < 0.01) and inhale-exhale volume (HR = 1.05, p < 0.05) are independent factors predicting OS after adjusting for age, sex, and performance status.ConclusionIt was feasible to use. It 4DCT scan for identifying thoracic calcifications in lung cancer patients treated with SBRT. Calcification volumes from inhale-exhale phases had the highest correlation with overall cardiac comorbidity and the average of the calcification volume obtained from these phases was an independent predictive factor for OS. |
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| Keywords: | Vascular calcification 4DCT Lung cancer Stereotactic body radiation therapy Cardiac comorbidity Myocardial infarction |
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