Evaluation of functionally weighted dose-volume parameters for thoracic stereotactic ablative radiotherapy (SABR) using CT ventilation

For the purpose of reducing radiation pneumontisis (RP), four-dimensional CT (4DCT)-based ventilation can be used to reduce functionally weighted lung dose. This study aimed to evaluate the functionally weighted dose-volume parameters and to investigate an optimal weighting method to realize effective planning optimization in thoracic stereotactic ablative radiotherapy (SABR). Forty patients treated with SABR were analyzed. Ventilation images were obtained from 4DCT using deformable registration and Hounsfield unit-based calculation. Functionally-weighted mean lung dose (fMLD) and functional lung fraction receiving at least x Gy (fVx) were calculated by two weighting methods: thresholding and linear weighting. Various ventilation thresholds (5th-95th, every 5th percentile) were tested. The predictive accuracy for CTCAE grade >= 2 pneumonitis was evaluated by area under the curve (AUC) of receiver operating characteristic analysis. AUC values varied from 0.459 to 0.570 in accordance with threshold and dose-volume metrics. A combination of 25th percentile threshold and fV(30) showed the best result (AUC: 0.570). AUC values with fMLD, fV(10), fV(20) and fV(40) were 0.541, 0.487, 0.548 and 0.563 using a 25th percentile threshold. Although conventional MLD, V-10, V-20, V-30 and V-40 showed lower AUC values (0.516, 0.477, 0.534, 0.552 and 0.527), the differences were not statistically significant. fV(30) with 25th percentile threshold was the best predictor of RP. Our results suggested that the appropriate weighting should be used for better treatment outcomes in thoracic SABR.