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Diagnostics
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Imaging of Treatment Response in Advanced Lung Cancer
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Imaging of Treatment Response in Advanced Lung Cancer

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (28 February 2022) | Viewed by 6249

Special Issue Editor

Dr. Farkhad Manapov

E-Mail Website
Guest Editor
Department of Radiation Oncology, University Hospital, Ludwig Maximilian University (LMU) of Munich, Marchioninistrasse 15, 81377 Munich, Germany
Interests: cancer; thorax; radiotherapy; chemotherapy; immunotherapy; multimodal; concurrent; radiosurgery; pneumonitis

Special Issue Information

Dear Colleagues,

The modern evolution of oncology is highly dependent on the continuous introduction of novel multimodal treatment strategies. The advent of immune checkpoint inhibitors has presented us with a new weapon in the armamentarium of anticancer drugs for advanced lung cancer. Additionally, the ensuing customization of treatment strategies has led to a radical increase in patients receiving multimodal therapy. In advanced lung cancer, the combination of chemotherapy, radiotherapy, surgery and immune checkpoint inhibition, either concurrently or sequentially, has led to a significant improvement in overall response rate and response duration, as well as consequently in progression-free survival and patient prognosis.

The synergistic effects of multimodal treatment strategy are continuously reported in pre-clinical models and clinical routine. In clinical practice, however, combined use of chemotherapy and immune checkpoint inhibition with modern radiation treatment and surgery needs further analysis and refinement. Overall response rate and duration, as well as multimodal treatment toxicity, can significantly vary in advanced lung cancer depending on the individual features of the treated tumour and patient.

There is a growing interest in comprehensive analysis of treatment response and response duration to multimodal therapy based on conventional diagnostics, non-invasive molecular imaging including hybrid systems and potential biomarkers derived from tumour tissue and patient blood. This comprehensive characterization will help one to optimize and facilitate patient selection and monitoring, especially taking into account the heath economic issues of a combined treatment approach.

For this research topic, we are interested in submissions addressing the morphological (imaging-based) and molecular-genetic characterisation of treatment response to multimodal therapy in advanced lung cancer. Studies concerning the implementation of new imaging protocols reporting on tumour volume changes in course of multimodal treatment, including chemotherapy and immune checkpoint inhibition combined with modern radiation treatment and surgery, are appreciated.  All submission types supported by Diagnostics will be considered, with priority given to original research articles, reviews and editorials.

Dr. Farkhad Manapov
Guest Editor

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 short 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. Diagnostics 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 2600 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

  • advanced lung cancer
  • multimodal imaging
  • combined treatment
  • chemotherapy
  • radiation
  • immune checkpoint inhibition
  • dynamic
  • metabolic
  • morphological
  • tumor
  • patient (host)

Published Papers (3 papers)

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Research

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16 pages, 822 KiB  
Article
Carbon Monoxide Diffusing Capacity (DLCO) Correlates with CT Morphology after Chemo-Radio-Immunotherapy for Non-Small Cell Lung Cancer Stage III
by Markus Stana, Brane Grambozov, Christoph Gaisberger, Josef Karner, Elvis Ruznic, Johannes Berchtold, Barbara Zellinger, Raphaela Moosbrugger, Michael Studnicka, Gerd Fastner, Felix Sedlmayer and Franz Zehentmayr
Diagnostics 2022, 12(5), 1027; https://doi.org/10.3390/diagnostics12051027 - 19 Apr 2022
Cited by 5 | Viewed by 1718
Abstract
Introduction: Curatively intended chemo-radio-immunotherapy for non-small cell lung cancer (NSCLC) stage III may lead to post-therapeutic pulmonary function (PF) impairment. We hypothesized that the decrease in global PF corresponds to the increase in tissue density in follow-up CTs. Hence, the study aim was [...] Read more.
Introduction: Curatively intended chemo-radio-immunotherapy for non-small cell lung cancer (NSCLC) stage III may lead to post-therapeutic pulmonary function (PF) impairment. We hypothesized that the decrease in global PF corresponds to the increase in tissue density in follow-up CTs. Hence, the study aim was to correlate the dynamics in radiographic alterations to carbon monoxide diffusing capacity (DLCO) and FEV1, which may contribute to a better understanding of radiation-induced lung disease. Methods: Eighty-five patients with NSCLC III were included. All of them received two cycles of platinum-based induction chemotherapy followed by high dose radiation. Thereafter, durvalumab was administered for one year in 63/85 patients (74%). Pulmonary function tests (PFTs) were performed three months and six months after completion of radiotherapy (RT) and compared to baseline. At the same time points, patients underwent diagnostic CT (dCT). These dCTs were matched to the planning CT (pCT) using RayStation® Model Based Segmentation and deformable image registration. Differential volumes defined by specific isodoses were generated to correlate them with the PFTs. Results: In general, significant correlations between PFTs and differential volumes were found in the mid-dose range, especially for the volume of the lungs receiving between 65% and 45% of the dose prescribed (V65−45%) and DLCO (p<0.01). This volume range predicted DLCO after RT (p-value 0.03) as well. In multivariate analysis, DLCO (p-value 0.040) and FEV1 (p-value 0.014) predicted pneumonitis. Conclusions: The current analysis revealed a strong relation between the dynamics of DLCO and CT morphology changes in the mid-dose range, which convincingly indicates the importance of routinely used PFTs in the context of a curative treatment approach. Full article
(This article belongs to the Special Issue Imaging of Treatment Response in Advanced Lung Cancer)
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11 pages, 2219 KiB  
Communication
Clinical Management and Outcome of Grade III Pneumonitis after Chemoradioimmunotherapy for Inoperable Stage III Non-Small Cell Lung Cancer—A Prospective Longitudinal Assessment
by Diego Kauffmann-Guerrero, Julian Taugner, Chukwuka Eze, Lukas Käsmann, Minglun Li, Amanda Tufman and Farkhad Manapov
Diagnostics 2021, 11(11), 1968; https://doi.org/10.3390/diagnostics11111968 - 23 Oct 2021
Cited by 5 | Viewed by 1650
Abstract
Background: Maintenance treatment with immune-checkpoint inhibition (ICI) has been shown to significantly improve patient prognosis after chemoradiotherapy (CRT) for inoperable stage III NSCLC. This survival advantage may be achieved at the expense of an increased probability for symptomatic pneumonitis as CRT as well [...] Read more.
Background: Maintenance treatment with immune-checkpoint inhibition (ICI) has been shown to significantly improve patient prognosis after chemoradiotherapy (CRT) for inoperable stage III NSCLC. This survival advantage may be achieved at the expense of an increased probability for symptomatic pneumonitis as CRT as well as ICI treatment is associated with the risk of treatment-related pulmonary toxicity. Methods: We screened a prospective chemoradioimmunotherapy (CRT-IO) cohort consisting of 38 patients and identified patients with therapy-related grade 3 pneumonitis. All patients were treated with intravenous high dose corticosteroids and closely monitored by CT-scans and extended longitudinal lung function tests. We analyzed lung function parameters and CT morphological features to characterize patients’ outcome. Results: Six (16%) patients treated with CRT-IO developed grade 3 pneumonitis one to six months after completion CRT. In the CT imaging, pneumonitis was characterized by diffuse ground glass capacities and in part pulmonary consolidations within and outside the planning target volume. Onset of pneumonitis was accompanied by a reduction in diffusion capacity in all cases. The mean decline of diffusion capacity was 25.8% [6–53%]. Under treatment with corticosteroids, all patients recovered regarding symptoms and changes in CT morphology. In five out of six patients, diffusion capacity improved to at least 80% of the baseline [80–96%]. One patient showed a significant increase of diffusion capacity after treatment (from 32% to 53%) but reached only 62% of the initial value. Conclusions: Pneumonitis is a severe complication of CRT-IO. High-resolution CT imaging and extended lung function testing proved to be a suitable approach in detecting and monitoring of CRT-IO associated pneumonitis. Full article
(This article belongs to the Special Issue Imaging of Treatment Response in Advanced Lung Cancer)
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Other

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5 pages, 953 KiB  
Case Report
Novel Multimodal Management of Post-Partum Synchronous Metastatic Pulmonary EBV-Associated Lymphoepithelioma-Like Carcinoma (LELC)—A Case Report
by Montserrat Pazos, Chukwuka Eze, Kathrin Kahnert, Maria Delius, Amanda Tufman, Irene Alba-Alejandre, Marcus Unterrainer, Jens Neumann, Thomas Kirchner and Farkhad Manapov
Diagnostics 2021, 11(11), 2072; https://doi.org/10.3390/diagnostics11112072 - 9 Nov 2021
Cited by 2 | Viewed by 1448
Abstract
Primary Epstein-Barr-Virus (EBV)-associated pulmonary lymphoepithelioma-like carcinoma (LELC) is an aggressive rare cancer. Higher incidences have been observed in Asian sub-populations. Multimodal treatment paradigms have emerged as promising novel strategies in the management of advanced NSCLC. In this report, we describe the case of [...] Read more.
Primary Epstein-Barr-Virus (EBV)-associated pulmonary lymphoepithelioma-like carcinoma (LELC) is an aggressive rare cancer. Higher incidences have been observed in Asian sub-populations. Multimodal treatment paradigms have emerged as promising novel strategies in the management of advanced NSCLC. In this report, we describe the case of a 34-year-old female patient of Asian origin with a post-partum initial diagnosis of pulmonary LELC. Multimodal treatment with chemoimmunotherapy and hypofractionated irradiation to the primary tumour and main metastatic sites led to a favourable response demonstrating that radiotherapy may potentially augment anti-tumour immunity. To the best of our knowledge, this is the first case report on this novel therapy strategy of multi-site hypofractionated radiotherapy and chemoimmunotherapy for metastatic pulmonary EBV-associated LELC. Full article
(This article belongs to the Special Issue Imaging of Treatment Response in Advanced Lung Cancer)
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