Vienna, Austria

ESTRO 2023

Session Item

May 14
10:30 - 11:30
Stolz 1
Corinne Faivre-Finn, United Kingdom;
Daniel Zips, Germany
Prospective trial of functional lung avoidance radiation for lung cancer: quality of life report
Brian Kavanagh, USA


Prospective trial of functional lung avoidance radiation for lung cancer: quality of life report

Joseph Lombardo1, Edward Castillo2, Richard Castillo3, Ryan Miller1, Bernard Jones4, Moyed Miften4, Brian Kavanagh4, Adam Dicker1, Cullen Boyle1, Nicole Simone1, Maria Werner-Wasik5, Inga Grills6, Thomas Guerrero7, Chad Rusthoven4, Yevgeniy Vinogradskiy8

1Thomas Jefferson University, Radiation Oncology, Philadelphia, USA; 2UT Austin, Department of Biomedical Engineering, Austin, USA; 3Emory University School of Medicine, Radiation Oncology, Atlanta, USA; 4University of Colorado, Radiation Oncology, Denver, USA; 5Thomas Jefferson University , Radiation Oncology, Philadelphia, USA; 6Beaumont Health, Radiation Oncology, Royal Oak, USA; 7UC San Diego, Radiation Oncology , San Diego, USA; 8Thomas Jefferson University, Radiation Oncology, Philadephia, USA

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Purpose or Objective

A novel form of lung function imaging has been developed that uses 4DCT data to generate lung ventilation images (4DCT-ventilation). Functional avoidance proposes to use 4DCT-ventilation to reduce doses to functional regions of the lung with the aim of reducing pulmonary side-effects. A 4DCT-ventilation functional avoidance, phase II, multi-center clinical trial was completed. Patient reported outcomes (PRO) are an essential measure of quality-of-life following radiotherapy. The purpose of this work is to quantify PRO changes for patients treated with functional avoidance and to compare functional avoidance PROs against historical values.

Material and Methods

Patients with locally advanced lung cancer receiving curative intent radiotherapy (prescription 45-75 Gy) and chemotherapy were accrued. Each patient had a 4DCT-ventilation image generated using 4DCT data and image processing. Favorable arc geometry and optimization techniques were used to generate functional avoidance-based plans. PRO instruments included the Functional Assessment of Cancer Therapy Lung (FACT-L) questionnaire, administered pre-treatment and at 3, 6, and 12 months post-treatment to gather data on physical, social, emotional, functional, and pulmonary well-being. Based on validated methods, the FACT-TOI (Trial Outcome Index) and the FACT-LCS (Lung Cancer Subscale) metrics were calculated, and the percentage of clinically meaningful PRO declines were determined. Published PROs for lung cancer patients treated with standard thoracic chemo-radiation were taken from a co-operative group lung cancer trial (60 Gy arm of RTOG 0617) and the rate of clinically significant FACT-TOI and FACT-LCS decline was compared against patients treated with functional avoidance via the chi-square test.


59 patients completed baseline PRO surveys. The median age was 65, 83% of patients had non-small-cell lung cancer, with 75% having stage III disease. The median dose was 60 Gy in 30 fractions. Clinically significant FACT-TOI decline was 46.3%, 38.5%, and 26.8%, at 3, 6, and 12 months, respectively. Clinically significant FACT-LCS decline was 33.3%, 33.3%, and 29.3%, at 3, 6, and 12 months, respectively. 26.8% of patients treated with functional avoidance had a clinically significant decline at 12 months in FACT-TOI compared to 47.8% for patients treated on RTOG 0617 (p=0.029).


The current work provides an innovative combination of functional avoidance and PROs and is the first report of patient-report outcomes for patients treated on a prospective 4DCT-ventilation functional avoidance trial. Approximately 30% of patients had a clinically significant decline in PROs that persisted at 12 months.  These results compare favorably to outcomes after standard thoracic chemo-radiation in RTOG 0617, where a decline at 12 months persisted in approximately half the patients. The study provides further evidence for improved outcomes with 4DCT-ventilation functional avoidance.