Systematic reviewFunctional lung imaging in radiation therapy for lung cancer: A systematic review and meta-analysis
Section snippets
Materials and methods
A systematic review was performed using structured search terms following the PRISMA guidelines [3]. This was prospectively registered on a systematic review database (PROSPERO, CRD42017077472).
The full review protocol is available attached in Appendix A. Publications were required to describe functional lung imaging in patients receiving treatment with radiation therapy in a peer reviewed journal. For the meta-analysis and descriptive tables, studies with less than 10 patients were excluded.
Results
A total of 114 publications met criteria for inclusion in the descriptive analysis [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74],
Discussion
This is the first systematic review and meta-analysis of functional lung imaging in radiation therapy for lung cancer. Multiple prior reviews were noted in the literature searches with a main focus on the technical aspects of functional lung imaging methods. Meta-analysis demonstrated that improved sparing of fMLD (2.18 Gy) and fV20 (4.19%) is observed when plans are optimised to spare functional compared lung. Several studies were discarded prior to meta-analysis due to insufficient data and
Conclusions
Our review of 114 publications demonstrates that functional lung imaging may provide additional information to assist in identifying patients at greater risk of radiation pneumonitis. We found a consistent dose–response with post radiation therapy perfusion imaging illustrating the potential for functional lung imaging to be integrated into treatment planning to improve functional dose metrics. Meta-analysis of reduction in fV20 and fMLD has demonstrated that functionally optimised treatment
Funding
This research was supported by an Australian National Health and Medical Research Council Grant APP1122347. This research was supported by an Australian Government Research Training Program (RTP) Scholarship.
Conflicts of interest notification
No actual or potential conflicts of interest exist.
Acknowledgement
The authors would like to acknowledge the contribution of Smaro Lazarakis, Librarian at the Health Sciences Library at Royal Melbourne Hospital.
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