Is individual perfusion dose-response different than ventilation dose-response for lung cancer patients treated with radiotherapy?

Farnoush Forghani, Richard Castillo, Edward Castillo, Bernard Jones, Chad Rusthoven, Jennifer Kwak, Vitali Moiseenko, Inga Grills, Moyed Miften, Yevgeniy Vinogradskiy, Thomas Guerrero

Research output: Contribution to journalArticlepeer-review


Objective: Current ventilation and perfusion dose– response studies focus on single-modalities (ventilation or perfusion) and perform pulmonary-toxicity assessment related to radiotherapy on a population-based basis. This study aims at quantitative and clinical evaluation of intrapatient differences between ventilation and perfusion dose–responses among lung cancer patients treated with radiotherapy. Methods: 20 patients enrolled on a prospective functional avoidance protocol underwent single photon emission computed tomography-CT ventilation and perfusion scans pre-and post-radiotherapy. Relative changes in pre-to post-treatment ventilation and perfusion in lung regions receiving ≥20 Gy were calculated. In addition, the slopes of the linear fit to the relative ventilation and perfusion changes in regions receiving 0–60 Gy were calculated. A radiologist read and assigned a functional defect score to pre-and post-treatment ventilation/perfusion scans. Results: 25% of patients had a difference >35% between ventilation and perfusion pre-to post-treatment changes and 20–30% of patients had opposite directions for ventilation and perfusion pre-to post-treatment changes. Using a semi-quantitative scale, radiologist assessment showed that 20% of patients had different pre-to post-treatment ventilation changes when compared to pre-to post-treatment perfusion changes. Conclusion: Our data showed that ventilation dose– response can differ from perfusion dose–response for 20–30% of patients. Therefore, when performing thoracic dose–response in cancer patients, it is insuffi-cient to look at ventilation or perfusion alone; but rather both modes of functional imaging may be needed when predicting for clinical outcomes. Advances in knowledge: The significance of this study can be highlighted by the differences between the intra-patient dose–response assessments of this analysis compared to existing population-based dose–response analyses. Elucidating intrapatient ventilation and perfusion dose–response differences may be valuable in predicting pulmonary toxicity in lung cancer patients post-radiotherapy.

Original languageEnglish
Article number20220119
JournalBritish Journal of Radiology
Issue number1143
StatePublished - Feb 1 2023


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