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Development of Imaging Complexity Biomarkers for Prediction of Symptomatic Radiation Pneumonitis in Patients with Non-Small Cell Lung Cancer, Focusing on Underlying Lung Disease

Authors :
Jeongeun Hwang
Hakyoung Kim
Joon-Young Moon
Sun Myung Kim
Dae Sik Yang
Source :
Life, Vol 14, Iss 11, p 1497 (2024)
Publication Year :
2024
Publisher :
MDPI AG, 2024.

Abstract

Objectives: We aimed to develop imaging biomarkers to predict radiation pneumonitis (RP) in non-small cell lung cancer (NSCLC) patients undergoing thoracic radiotherapy. We hypothesized that measuring morphometric complexity in the lung using simulation computed tomography may provide objective imaging biomarkers for lung parenchyma integrity, potentially forecasting the risk of RP. Materials and Methods: A retrospective study was performed on medical records of 175 patients diagnosed with NSCLC who had received thoracic radiotherapy. Three indices were utilized to measure the morphometric complexity of the lung parenchyma: box-counting fractal dimension, lacunarity, and minimum spanning tree (MST) fractal dimension. Patients were dichotomized into two groups at median values. Cox proportional hazard models were constructed to estimate the hazard ratios for grade ≥ 2 or grade ≥ 3 RP. Results and Conclusions: We found significant associations between lung parenchymal morphometric complexity and RP incidence. In univariate Cox-proportional hazard analysis, patients with a lower MST fractal dimension had a significantly higher hazard ratio of 2.296 (95% CI: 1.348–3.910) for grade ≥ 2 RP. When adjusted for age, sex, smoking status, category of the underlying lung disease, category of radiotherapy technique, clinical stage, histology, and DLCO, patients with a lower MST fractal dimension showed a significantly higher hazard ratio of 3.292 (95% CI: 1.722–6.294) for grade ≥ 2 RP and 7.952 (95% CI: 1.722 36.733) for grade ≥ 3 RP than those with a higher MST fractal dimension. Patients with lower lacunarity exhibited a significantly lower hazard ratio of 0.091 (95% CI: 0.015–0.573) for grade ≥ 3 RP in the adjusted model. We speculated that the lung tissue integrity is captured by morphometric complexity measures, particularly by the MST fractal dimension. We suggest the MST fractal dimension as an imaging biomarker for predicting the occurrence of symptomatic RP after thoracic radiotherapy.

Details

Language :
English
ISSN :
14111497 and 20751729
Volume :
14
Issue :
11
Database :
Directory of Open Access Journals
Journal :
Life
Publication Type :
Academic Journal
Accession number :
edsdoj.78bb9ed17dc4ad89b0718bd7c38f2bb
Document Type :
article
Full Text :
https://doi.org/10.3390/life14111497