This study tested the hypothesis that shows advanced image analysis can differentiate fit and unfit patients for radical radiotherapy from standard radiotherapy planning imaging, when compared to formal lung function tests (FEV1, Forced Expiratory Volume in 1 second) and TLCO (Transfer Factor of Carbon Monoxide).
An apical region of interest (ROI) of lung parenchyma was extracted from a standard radiotherapy planning CT scan. Software using a grey level co-occurrence matrix (GLCM) assigned an entropy score to each voxel, based on its similarity to the voxels around it. Density and entropy scores were compared between a cohort of fit patients (defined as FEV1 and TLCO above 50% predicted value) and unfit patients (FEV1 or TLCO below 50% predicted).
29 fit and 32 unfit patients were included. Mean and median density and mean and median entropy were significantly different between fit and unfit patients (p= 0.0021, 0.0019, 0.0357 and 0.0363 respectively, 2 sided t-test).
Density and entropy assessment can differentiate between fit and unfit patients for radical radiotherapy, using standard CT imaging.
Advances in knowledge
This study shows that a novel intervention can generate further data from standard CT imaging. This data could be combined with existing studies to form a multi-organ patient fitness assessment from a single CT scan.
- Phillips et al. Clinical Applications of textural analysis in Non-Small Cell Lung cancer. British Journal of Radiology, in press
- Okonji D, Sinha R, Phillips I, Fatz D & Ring A. Comprehensive Geriatric Assessment in 326 older women with early breast cancer. 2017, British Journal of Cancer. 117 925-931
- Phillips et al. Benefits of Stereotactic Fellowships to Clinical Oncology Trainees. Letter in Clinical Oncology, 2016 28(12)e221.
- Dean JA, Welsh, LC, Wong KH, Aleksic A, Dunne E, Islam MR, Patel A, Patel P, Petkar I, Phillips I et al. ANormal Tissue Complication Probability (NTCP) Modelling of Severe Acute Mucositis using a Novel Oral Mucosal Surface Organ at Risk. 2017, in press.
- Dean JA, Welsh LC, McQuaid D, Wong KH, Aleksic A, Dunne E, Islam MR, Patel A, Patel P, Petkar I, Phillips I et al. Assessment of fully-automated atlas-based segmentation of novel oral mucosal surface organ-at-risk. 2016, Radiotherapy and Oncology. 2016 Apr;119(1):166-71
- Phillips I et al. Converting inoperable colorectal liver metastases to operable; data from a UK perspective. 2015, Letter in Clinical Oncology. 2015 Jul;27(7):427
- Phillips I et al. Androgen Deprivation Therapy and the Re-emergence of Parenteral Estrogen in Prostate Cancer. Oncology and Haematology Reviews. 2014, 10(1)42-4
- Phillips I, et al., Aspirin as a Treatment for Cancer, Clinical Oncology 2013, 25(6)333-335
- Phillips, I and Brown, C. Case Presentation: HIV and lymphoma, Mimms Journal of Oncology and Palliative Care. 2009
- Phillips et al. G8 assessment predicts whether patients with lung cancer are fit for anti-cancer treatment. European Journal of Surgical Oncology. In press
- Phillips et al. Stereotactic radiotherapy for primary lung cancer. Clinical Oncology, 2017, (29) S10
- Alobaidli, South, McQuaid, Scuffham, Phillips et al. A dose painting study based on CT intra-tumoral heterogeneity vs FDG PET uptake in NSCLC. Radiotherapy & Oncology. 2017. S1 S841
- Hug, Phillips et al. Analysis of the incidence of cancer cachexia in patients with advanced lung cancer at referral to a dietitian. Journal of Thoracic Oncology. 2017, 12(S1)S346
- Hug, Phillips et al. Rate of cachexia in lung cancer. European Journal of Surgical Oncology. 2016, 42(11)S227
- Phillips et al. Sarcopenia in Lung Cancer. European Journal of Surgical Oncology. 2016, 42(11)S238.
- Ezhil, Phillips et al. Audit of treatment of older patients with lung cancer. Clinical Oncology. 2017, (28)S4