Laura Cella1, Serena Monti2, Ting Xu3, Raffaele Liuzzi2, Arnaldo Stanzione4, Marco Durante5, Radhe Mohan6, Zhongxing Liao3, Giuseppe Palma7. 1. National Research Council, Institute of Biostructures and Bioimaging, Napoli, Italy. Electronic address: laura.cella@cnr.it. 2. National Research Council, Institute of Biostructures and Bioimaging, Napoli, Italy. 3. MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA. 4. Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Napoli, Italy. 5. GSI Helmholtz Centre for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany. 6. MD Anderson Cancer Center, Department of Radiation Physics, Houston, USA. 7. National Research Council, Institute of Biostructures and Bioimaging, Napoli, Italy. Electronic address: giuseppe.palma@ibb.cnr.it.
Abstract
PURPOSE: To investigate thoracic dose-response patterns for pericardial effusion (PCE) and mortality in patients treated for locally advanced Non-Small-Cell Lung Cancer (NSCLC) by Intensity Modulated RT (IMRT) or Passive-Scattering Proton Therapy (PSPT). METHODS: Among 178 patients, 43.5% developed grade ≥ 2 PCE. Clinical and dosimetric factors associated with PCE or overall survival (OS) were identified via multi-variable Cox proportional hazards modeling. The Voxel-Based Analyses (VBAs) of local dose differences between patients with and without PCE and mortality was performed. The robustness of VBA results was assessed by a novel characterization of spatial properties of dose distributions based on probabilistic independent component analysis (PICA) and connectograms. RESULTS: Several non-dosimetric variables were selected by the multivariable analysis for the considered outcomes, while the time-dependent PCE onset was uncorrelated with the OS (p = 0.34) at a multi-variable Cox analysis. Despite the significant PSPT dosimetric advantage, the RT technique did not affect the occurrence of PCE or OS. VBAs highlighted largely overlapping clusters significantly associated with PCE endpoints in heart and lungs. No significant dosimetric patterns related to mortality endpoints were found. PICA identified 43 components homogeneously scattered within thorax, while connectograms showed modest correlations between doses in main cardio-pulmonary substructures. CONCLUSIONS: Spatially resolved analysis highlighted dose patterns related to radiation-induced cardiac toxiciy and the observed organ-based dose-response mismatch in PSPT and IMRT. Indeed, the thoracic regions spared by PSPT poorly overlapped with the areas involved in PCE development, as highlited by VBA. PICA and connectograms proved valuable tools for assessing the robusteness of obtained VBA inferences.
PURPOSE: To investigate thoracic dose-response patterns for pericardial effusion (PCE) and mortality in patients treated for locally advanced Non-Small-Cell Lung Cancer (NSCLC) by Intensity Modulated RT (IMRT) or Passive-Scattering Proton Therapy (PSPT). METHODS: Among 178 patients, 43.5% developed grade ≥ 2 PCE. Clinical and dosimetric factors associated with PCE or overall survival (OS) were identified via multi-variable Cox proportional hazards modeling. The Voxel-Based Analyses (VBAs) of local dose differences between patients with and without PCE and mortality was performed. The robustness of VBA results was assessed by a novel characterization of spatial properties of dose distributions based on probabilistic independent component analysis (PICA) and connectograms. RESULTS: Several non-dosimetric variables were selected by the multivariable analysis for the considered outcomes, while the time-dependent PCE onset was uncorrelated with the OS (p = 0.34) at a multi-variable Cox analysis. Despite the significant PSPT dosimetric advantage, the RT technique did not affect the occurrence of PCE or OS. VBAs highlighted largely overlapping clusters significantly associated with PCE endpoints in heart and lungs. No significant dosimetric patterns related to mortality endpoints were found. PICA identified 43 components homogeneously scattered within thorax, while connectograms showed modest correlations between doses in main cardio-pulmonary substructures. CONCLUSIONS: Spatially resolved analysis highlighted dose patterns related to radiation-induced cardiac toxiciy and the observed organ-based dose-response mismatch in PSPT and IMRT. Indeed, the thoracic regions spared by PSPT poorly overlapped with the areas involved in PCE development, as highlited by VBA. PICA and connectograms proved valuable tools for assessing the robusteness of obtained VBA inferences.
Authors: Laura Cella; Vittoria D'Avino; Giuseppe Palma; Manuel Conson; Raffaele Liuzzi; Marco Picardi; Maria Cristina Pressello; Genoveva Ionela Boboc; Roberta Battistini; Vittorio Donato; Roberto Pacelli Journal: Radiother Oncol Date: 2015-08-12 Impact factor: 6.280
Authors: Xiong Wei; H Helen Liu; Susan L Tucker; Shulian Wang; Radhe Mohan; James D Cox; Ritsuko Komaki; Zhongxing Liao Journal: Int J Radiat Oncol Biol Phys Date: 2008-01-11 Impact factor: 7.038
Authors: Katelyn M Atkins; Bhupendra Rawal; Tafadzwa L Chaunzwa; Nayan Lamba; Danielle S Bitterman; Christopher L Williams; David E Kozono; Elizabeth H Baldini; Aileen B Chen; Paul L Nguyen; Anthony V D'Amico; Anju Nohria; Udo Hoffmann; Hugo J W L Aerts; Raymond H Mak Journal: J Am Coll Cardiol Date: 2019-06-18 Impact factor: 24.094
Authors: Laura Cella; Raffaele Liuzzi; Vittoria D'Avino; Manuel Conson; Angela Di Biase; Marco Picardi; Novella Pugliese; Raffaele Solla; Marco Salvatore; Roberto Pacelli Journal: Acta Oncol Date: 2013-11-06 Impact factor: 4.089
Authors: Laura Cella; Giuseppe Palma; Joseph O Deasy; Jung Hun Oh; Raffaele Liuzzi; Vittoria D'Avino; Manuel Conson; Novella Pugliese; Marco Picardi; Marco Salvatore; Roberto Pacelli Journal: PLoS One Date: 2014-10-31 Impact factor: 3.240
Authors: Lydia J Wilson; Abigail Bryce-Atkinson; Andrew Green; Yimei Li; Thomas E Merchant; Marcel van Herk; Eliana Vasquez Osorio; Austin M Faught; Marianne C Aznar Journal: Phys Med Date: 2022-05-21 Impact factor: 3.119
Authors: Laura Cella; Serena Monti; Maria Thor; Andreas Rimner; Joseph O Deasy; Giuseppe Palma Journal: Cancers (Basel) Date: 2021-07-25 Impact factor: 6.639