Magnetic resonance imaging biomarkers of chronic obstructive pulmonary disease prior to radiation therapy for non-small cell lung cancer

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Abstract

Objective: In this prospectively planned interim-analysis, the prevalence of chronic obstructive lung disease (COPD) phenotypes was determined using magnetic resonance imaging (MRI) and X-ray computed tomography (CT) in non-small-cell-lung-cancer (NSCLC) patients. Materials and methods: Stage-III-NSCLC patients provided written informed consent for pulmonary function tests, imaging and the 6-min-walk-test. Ventilation defect percent (VDP) and CT lung density (relative-of-CT-density-histogram <-950, RA<inf>950</inf>) were measured. Patients were classified into three subgroups based on qualitative and quantitative COPD and tumour-specific imaging phenotypes: (1) tumour-specific ventilation defects (TSD), (2) tumour-specific and other ventilation defects without emphysema (TSD<inf>V</inf>), and, (3) tumour-specific and other ventilation defects with emphysema (TSD<inf>VE</inf>). Results: Seventeen stage-III NSCLC patients were evaluated (68±7 years, 7M/10F, mean FEV<inf>1</inf>=77%<inf>pred</inf>) including seven current and 10 ex-smokers and eight patients with a prior lung disease diagnosis. There was a significant difference for smoking history (p=02) and FEV<inf>1</inf>/FVC (p=04) for subgroups classified using quantitative imaging. Patient subgroups classified using qualitative imaging findings were significantly different for emphysema (RA<inf>950</inf>, p<.001). There were significant relationships for whole-lung VDP (p<.05), but not RECIST or tumour-lobe VDP measurements with pulmonary function and exercise measurements. Preliminary analysis for non-tumour burden ventilation abnormalities using Reader-operator-characteristic (ROC) curves reflected a 94% classification rate for smoking pack-years, 93% for FEV<inf>1</inf>/FVC and 82% for RA<inf>950</inf>. ROC sensitivity/specificity/positive/negative likelihood ratios were also generated for pack-years, (0.92/0.80/4.6/0.3), FEV<inf>1</inf>/FVC (0.92/0.80/4.6/0.3), RA<inf>950</inf> (0.92/0.80/4.6/0.3) and RECIST (0.58/0.80/2.9/1.1). Conclusions: In this prospectively planned interim-analysis of a larger clinical trial, NSCLC patients were classified based on COPD imaging phenotypes. A proof-of-concept evaluation showed that FEV<inf>1</inf>/FVC and smoking history identified NSCLC patients with ventilation abnormalities appropriate for functional lung avoidance radiotherapy.

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Sheikh, K., Capaldi, D. P. I., Hoover, D. A., Palma, D. A., Yaremko, B. P., & Parraga, G. (2015). Magnetic resonance imaging biomarkers of chronic obstructive pulmonary disease prior to radiation therapy for non-small cell lung cancer. European Journal of Radiology Open, 2, 81–89. https://doi.org/10.1016/j.ejro.2015.05.003

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