A Brief Report on the Role of SPECT/TC in the Optimization of Radiotherapy Treatment with Radical Intent for Unresectable Stage III NSCLC

Background: The standard treatment for locally advanced non-small cell lung cancer (LA-NSCLC) is represented by concomitant chemo-radiotherapy followed consolidation with durvalumab that ensures a 5-year survival of 46%. However, the risk radiotherapy-induced pneumonia (RIP) almost 10–15%. Complete cardiological examination also usually performed during cardiopulmonary pre-treatment evaluation and pulmonary function testing one most used tool to predict RIP development. Aim: aim this study investigate impact Tc-99 macroaggregated albumin (MAA) perfusion scan single photon emission-computed tomography/computed tomography (SPECT/CT) in preliminary assessment functions its potential role optimization radiotherapy planning. Methods: Descriptive statistical analysis were on eight patients affected unresectable stage III LA-NSCLC treated chemo-radiotherapy. Before starting radiotherapy, underwent SPECT/CT. SPECT/CT images firstly co-registered simulation CT ones, then specific region interest (ROI) volumes was created represent areas at least 20% 40%, 60% 80% maximum perfusion, respectively. Finally, plan preserving better perfused volumes. dosimetric correlations both plans made comparing V20 V5, mean pulmonary, esophagus heart dose. Results: From DVH comparative two (standard versus SPECT optimized one) obtained each patient, data confirmed an equal coverage target volume while respecting all lungs, dose constraints. At same time, SPECT-optimized allowed reduce average Conclusions: Lung scintigraphy could be considered explore stratify SPECT/TC may proposed as painting optimize plans. Only prospective will enable us confirm real reduction optimal perfusion.