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Cancers
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Advancements in Image-Guided Radiotherapy for the Treatment of Lung Cancer
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Advancements in Image-Guided Radiotherapy for the Treatment of Lung Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 3032

Special Issue Editors

Dr. François Lucia

E-Mail Website
Guest Editor
Radiation Oncology Department, University Hospital, 29200 Brest, France
Interests: lung cancer; functional imaging; stereotactic body radiotherapy; radiomics; quality of life; biomarkers
Dr. Vincent Bourbonne

E-Mail Website
Guest Editor
Radiation Oncology Department, CHU de Brest, Brest, France
Interests: lung cancer; functional imaging; stereotactic body radiotherapy; radiomics; quality of life; biomarkers

Special Issue Information

Dear Colleagues,

Image-guided radiotherapy (IGRT) takes place at every step of the treatment in lung cancer, from treatment planning with fusion imaging, to daily in-room repositioning. Managing tumor and organ motion has been possible since the introduction of routine four-dimensional computed tomography (4DCT) use. The assessment of respiratory motion has been performed with “passive” techniques based on reconstruction images from 4DCT planning, or “active” techniques adapted to the patient's breathing. Additionally metabolic imaging has a great importance in radiotherapy planning, dose delivering and adaptive approach, with the aim to increase the accuracy in target definition and sparing of healthy tissues. Magnetic resonance imaging (MRI) and functional imaging also play an important role in lung cancer radiation and open the way for adaptive RT. Topics for this Special Issue include technical advances in RT and their clinical impact on lung cancer treatment.

Dr. François Lucia
Dr. Vincent Bourbonne
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • lung cancer
  • functional imaging
  • stereotactic body radiotherapy
  • radiomics
  • biomarkers
  • artificial intelligence
  • magnetic resonance imaging

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Published Papers (2 papers)

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Research

18 pages, 3540 KiB  
Article
A Retrospective Analysis of the First Clinical 5DCT Workflow
by Michael Lauria, Minji Kim, Dylan O’Connell, Yi Lao, Claudia R. Miller, Louise Naumann, Peter Boyle, Ann Raldow, Alan Lee, Ricky R. Savjani, Drew Moghanaki and Daniel A. Low
Cancers 2025, 17(3), 531; https://doi.org/10.3390/cancers17030531 - 5 Feb 2025
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Abstract
Background/Objectives: 5DCT was first proposed in 2005 as a motion-compensated CT simulation approach for radiotherapy treatment planning to avoid sorting artifacts that arise in 4DCT when patients breathe irregularly. Since March 2019, 5DCT has been clinically implemented for routine use at our institution [...] Read more.
Background/Objectives: 5DCT was first proposed in 2005 as a motion-compensated CT simulation approach for radiotherapy treatment planning to avoid sorting artifacts that arise in 4DCT when patients breathe irregularly. Since March 2019, 5DCT has been clinically implemented for routine use at our institution to leverage this technological advantage. The clinical workflow includes a quality assurance report that describes the output of primary workflow steps. This study reports on the challenges and quality of the clinical 5DCT workflow using these quality assurance reports. Methods: We evaluated all thoracic 5DCT simulation datasets consecutively acquired at our institution between March 2019 and December 2022 for thoracic radiotherapy treatment planning. The 5DCT datasets utilized motion models constructed from 25 fast-helical free-breathing computed tomography (FHFBCTs) with simultaneous respiratory bellows signal monitoring to reconstruct individual, user-specified breathing-phase images (termed 5DCT phase images) for internal target volume contouring. Each 5DCT dataset was accompanied by a structured quality assurance report composed of qualitative and quantitative measures of the breathing pattern, image quality, DIR quality, model fitting accuracy, and a validation process by which the original FHFBCT scans were regenerated with the 5DCT model. Measures of breathing irregularity, image quality, and DIR quality were retrospectively categorized on a grading scale from 1 (regular breathing and accurate registration/modeling) to 4 (irregular breathing and inaccurate registration/modeling). The validation process was graded according to the same scale, and this grade was termed the suitability-for-treatment-planning (STP) grade. We correlated the graded variables to the STP grade. In addition to the quality assurance reports, we reviewed the contour sessions to determine how often 5DCT phase images were used for treatment planning and delivery. Results: There were 169 5DCT simulation datasets available from 156 patients for analysis. The STP was moderately correlated with breathing irregularity, image quality, and DIR quality (Spearman coefficients: 0.26, 0.30, and 0.50, respectively). Multiple linear regression analysis demonstrated that STP was correlated with regular breathing patterns (p = 0.008), image quality (p < 0.001), and better DIR quality (p < 0.001). 5DCT datasets were used for treatment planning in 82% of cases, while in 12% of cases, a backup image process was used. In total, 6% of image datasets were not used for treatment planning due to factors unrelated to the 5DCT workflow quality. Conclusions: The strongest association with STP was with DIR quality grades, as indicated by both Spearman and multiple linear regression analysis, implying that improvements to DIR accuracy and evaluation may be the best route for further improvement to 5DCT. The high rate of 5DCT phase image use for treatment planning showed that the workflow was reliable, and this has encouraged us to continue to develop and improve the workflow steps. Full article
(This article belongs to the Special Issue Advancements in Image-Guided Radiotherapy for the Treatment of Lung Cancer)
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11 pages, 2402 KiB  
Article
Optimizing Choice of Skin Surrogates for Surface-Guided Stereotactic Body Radiotherapy of Lung Lesions Using Four-Dimensional Computed Tomography
by Vanda Leipold, Ivana Alerić, Mihaela Mlinarić, Domagoj Kosmina, Fran Stanić, Mladen Kasabašić, Damir Štimac, Hrvoje Kaučić, Giovanni Ursi, Karla Schwarz, Igor Nikolić, Denis Klapan and Dragan Schwarz
Cancers 2024, 16(13), 2358; https://doi.org/10.3390/cancers16132358 - 27 Jun 2024
Viewed by 1983
Abstract
Image-guided radiotherapy supported by surface guidance can help to track lower lung lesions’ respiratory motion while reducing a patient’s exposure to ionizing radiation. However, it is not always clear how the skin’s respiratory motion magnitude and its correlation with the lung lesion’s respiratory [...] Read more.
Image-guided radiotherapy supported by surface guidance can help to track lower lung lesions’ respiratory motion while reducing a patient’s exposure to ionizing radiation. However, it is not always clear how the skin’s respiratory motion magnitude and its correlation with the lung lesion’s respiratory motion vary between different skin regions of interest (ROI). Four-dimensional computed tomography (4DCT) images provide information on both the skin and lung respiratory motion and are routinely acquired for the purpose of treatment planning in our institution. An analysis of 4DCT images for 57 patients treated in our institution has been conducted to provide information on the respiratory motion magnitudes of nine skin ROIs of the torso, a tracking structure (TS) representing a lower lung lobe lesion, as well as the respiratory motion correlations between the nine ROIs and the TS. The effects of gender and the adipose tissue volume and distribution on these correlations and magnitudes have been analyzed. Significant differences between the ROIs in both the respiratory motion magnitudes and their correlations with the TS have been detected. An overall negative correlation between the ROI respiratory magnitudes and the adipose tissue has been detected for ROIs with rib cage support. A weak to moderate negative correlation between the adipose tissue volume and ROI-to-TS respiratory correlations has been detected for upper thorax ROIs. The respiratory magnitudes in regions without rib support tend to be larger for men than for women, but no differences in the ROI-to-TS correlation between sexes have been detected. The described findings should be considered when choosing skin surrogates for lower lung lesion motion management. Full article
(This article belongs to the Special Issue Advancements in Image-Guided Radiotherapy for the Treatment of Lung Cancer)
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