Cancer Research and Treatment

Original Articles

Assessing Radiation Pneumonitis Through Functional Lung Imaging: A Single Photon Emission Computed Tomography (SPECT)-Based Approach in Lung Cancer: Joo-Hyun Chung, Soo Jin Lee, Ji Young Kim, Hae Jin Park; Received November 13, 2025 Accepted February 18, 2026 Published online February 19, 2026; DOI: https://doi.org/10.4143/crt.2025.1248 [Accepted]

Abstract PDF: Purpose
To develop models to assess the risk of symptomatic radiation pneumonitis (SRP) (Common Terminology Criteria for Adverse Events 4.03 grade ≥ 2) in lung cancer patients by utilizing single-photon emission computed tomography (SPECT) for functional lung volume identification and dosimetric analysis.
Materials and Methods
This retrospective study included 71 lung cancer patients who underwent SPECT before radiotherapy from 2018 to 2024. Perfusion and ventilation SPECT images were co-registered with planning CT to define functional and anatomical lung volumes. Functional lung was defined as voxels with ≥ 20% of the maximum intensity on SPECT. Models to assess the risk of SRP were constructed using Cox regression and evaluated using corrected Akaike Information Criterion (AICc) and time-dependent receiver operating characteristic analysis.
Results
At a median follow-up of 16.8 months, 19 of 71 patients (26.8%) developed SRP. Factors significantly associated with SRP risk included planning target volume ≥ 150 mL, percentage of total perfusion-defined functional lung receiving ≥ 10 Gy (pVf10) exceeding that of total anatomical lung receiving ≥ 10 Gy (V10), percentage of total ventilation-defined lung receiving ≥ 10 Gy (vVf10) ≥ 45%, and ipsilateral vVf10 ≥ 60% (p=0.004, 0.004, 0.024, and 0.007, respectively). Among the three models, the model incorporating additional ventilation-based parameters demonstrated the best performance (AICc = 85.81, area under the curve = 0.819).
Conclusion
SPECT-based dosimetric parameters derived from perfusion and ventilation are significantly associated with the risk of SRP. Incorporating SPECT may improve risk stratification and enable lung-sparing strategies.

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Lung and Thoracic cancer

Efficacy of Prophylactic Cranial Irradiation According to the Risk of Extracranial Recurrence in Limited-Stage Small Cell Lung Cancer: Tae Hoon Lee, Joo-Hyun Chung, Hong-Gyun Wu, Suzy Kim, Joo Ho Lee, Bhumsuk Keam, Jin-Soo Kim, Ki Hwan Kim, Byoung Hyuck Kim, Hak Jae Kim; Cancer Res Treat. 2023;55(3):875-884. Published online February 24, 2023; DOI: https://doi.org/10.4143/crt.2022.1583

Abstract PDF Supplementary Material PubReader ePub

Purpose
We aimed to evaluate the effectiveness of prophylactic cranial irradiation (PCI) for “early brain metastasis”, which occurs before extracranial recurrence (ECR), and “late brain metastasis”, which occurs after ECR, in limited-stage small cell lung cancer (LS-SCLC).
Materials and Methods
We retrospectively analyzed 271 LS-SCLC patients who underwent definitive chemoradiation. All patients were initially staged with brain magnetic resonance imaging and positron emission tomography. Intracranial recurrence (ICR), ECR, progression-free rate (PFR), and overall survival (OS) were analyzed as clinical endpoints. The competing risk of the first recurrence with ICR (ICRfirst) was evaluated. Significantly associated variables in multivariate analysis of ECR were considered as ECR risk factors. Patients were stratified according to the number of ECR risk factors.
Results
The application of PCI was associated with higher PFR (p=0.008) and OS (p=0.045). However, PCI was not associated with any of the clinical endpoints in multivariate analysis. The competing risk of ICRfirst was significantly decreased with the application of PCI (hazard ratio, 0.476; 95% confidence interval, 0.243 to 0.931; p=0.030). Stage III disease, sequential, and stable disease after thoracic radiation were selected as ECR risk factors. For patients without these risk factors, the application of PCI was significantly associated with increased OS (p=0.048) and a decreased risk of ICRfirst (p=0.026).
Conclusion
PCI may play a role in preventing early brain metastasis rather than late brain metastasis after ECR, suggesting that only patients with a low risk of ECR may currently benefit from PCI.

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Efficacy evaluation of prophylactic cranial irradiation for limited stage small‑cell lung cancer in the magnetic resonance imaging era: A meta‑analysis
Lihua Shao, Yumei Dong, Meiqiao Jiang, Haixia Song, Yuexiao Qi, Liyun Guo, Jinhui Tian, Shihong Wei
Oncology Letters.2025;[Epub] CrossRef

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Analysis of Once-Daily Thoracic Radiotherapy Dose According to the Underlying Lung Disease in Patients with Limited-Stage Small Cell Lung Cancer Undergoing Concurrent Chemoradiotherapy: Byoung Hyuck Kim, Joo-Hyun Chung, Jaeman Son, Suzy Kim, Hong-Gyun Wu, Hak Jae Kim; Cancer Res Treat. 2023;55(1):73-82. Published online March 14, 2022; DOI: https://doi.org/10.4143/crt.2021.1202

Abstract PDF Supplementary Material PubReader ePub

Purpose
In the treatment of concurrent chemoradiotherapy (CCRT) in limited-stage small cell lung cancer, the optimal once-daily radiotherapy (RT) dose/fractionation remain unclear although it is the most frequently used. Therefore, this study aimed to compare the treatment outcomes and toxicities of modest dose RT (≤ 54 Gy) with those of standard dose RT (> 54 Gy) and investigate the benefit of the high dose based on patient factors.
Materials and Methods
Since 2004, our institution has gradually increased the thoracic RT dose. Among the 225 patients who underwent CCRT, 84 patients (37.3%) received > 54 Gy. Because the patients treated with RT > 54 Gy were not randomly assigned, propensity score matching (PSM) was performed.
Results
The proportion of patients treated with > 54 Gy increased over time (p=0.014). Multivariate analysis revealed that the overall tumor stage and dose > 54 Gy (hazard ratio, 0.65; p=0.029) were independent prognostic factors for overall survival (OS). PSM confirmed that thoracic RT doses of > 54 Gy showed significantly improved progression-free survival (3-year, 42.7% vs. 24.0%; p < 0.001) and OS (3-year, 56.2% vs. 38.5%; p=0.003). Sensitivity analysis also showed that 60 Gy resulted in better survival than 54 Gy. However, in patients with underlying lung disease, OS benefit from > 54 Gy was not observed but considerable rates of severe pulmonary toxicities were observed (p=0.001).
Conclusion
Our analysis supports that the 60 Gy RT dose should be considered in the once-daily regimen of CCRT for limited-stage small cell lung cancer without underlying lung disease, but RT dose > 54 Gy did not seem to benefit for patients with chronic obstructive pulmonary disease or interstitial lung disease. Further study is needed to validate these results.

Citations

Citations to this article as recorded by

The Dose/Fractionation Debate in Limited-Stage Small Cell Lung Cancer
Kaixin Du, Xuehong Liao, Kazushi Kishi
Cancers.2024; 16(10): 1908. CrossRef
Outcome of dose-escalated intensity-modulated radiotherapy for limited disease small cell lung cancer
Eunyeong Yang, Young Seob Shin, Ji Hyeon Joo, Wonsik Choi, Su Ssan Kim, Eun Kyung Choi, Jaeha Lee, Si Yeol Song
Radiation Oncology Journal.2023; 41(3): 199. CrossRef

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