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Z. Hao



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    P3.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 235)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Biology, Pathology, and Molecular Testing
    • Presentations: 1
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      P3.04-104 - Radiation Pneumonitis: Assessment by Inflammation Imaging with Tc-99m HMPAO - Clinical Trial in Progress (ID 2790)

      09:30 - 09:30  |  Author(s): Z. Hao

      • Abstract
      • Slides

      Background:
      Background: Over 60% of patients with non-small-cell lung carcinoma (NSCLC) require radiation treatment, with an overall cure rate < 10-15% and moderate toxicity in 10-30% of treated patients. While high-dose radiation improves survival, concern over radiation-induced toxicities including radiation pneumonitis (RP) have limited its use. Predicting probability of tumor control and lung toxicity offers a promising strategy for individualized radiation therapy (RT), such as giving higher dose radiation to resistant tumors when probability of toxicity is low, improving the therapeutic ratio. Technetium-99m (Tc-99m) hexamethylpropylene amine oxime (HMPAO) imaging is an established method for evaluation of brain perfusion, tissue inflammation, infection, and abscess localization. Tc-99m HMPAO, a lipophilic biogenic amine that easily crosses the cell membrane into the endothelial cytoplasm, is a sensitive indicator of endothelial cell damage and microvascular injury, penetrating into the alveolar macrophage reflecting impaired alveolar integrity proportional to inflammation and lung toxicity. Once intracellular, it is retained by conversion to hydrophilic nondiffusable form mediated by glutathione oxidation/reduction within the epithelial lining and bronchoalveolar cell, and has been used for non-invasive detection of lung injury proportional to severity. We used Tc-99m HMPAO scintigraphy to semiquantitatively document the presence and severity of lung toxicity in 4 patients undergoing RT for NSCLC.

      Methods:
      Methods: Four patients with NSCLC (3 Stage IIIB receiving concurrent RT and carboplatin/paclitaxel chemotherapy, 1 Stage IB RT alone) underwent lung computed tomography (CT), positron emission tomography (PET)/CT with 2-deoxy-2-[fluorine-18]fluoro-D-glucose (FDG), ventilation (V)/perfusion (Q) lung imaging with Tc-99m diethylene triamine pentaacetic acid/Tc-99m macroaggregated albumin, and inflammation imaging with Tc-99m HMPAO; at baseline prior to treatment, during RT after 36-50 Gray, and at 3 months following radiation completion.

      Results:
      Results: All patients had matching V/Q lung abnormalities in the areas of tumor and RT, and tumor-positive baseline FDG PET/CT imaging that showed response to therapy. Three patients without RP had HMPAO imaging that mimicked Q lung imaging on all 3 sequential imaging studies. No patient experienced RP during RT, while one patient experienced grade 1 RP at 3 months, showing progressive increase in HMPAO inflammatory uptake in adjacent lung from baseline to during-RT to 3 months post-RT imaging, not appreciated on FDG PET/CT imaging (Figure 1).

      Conclusion:
      Conclusion: Tc-99m HMPAO nuclear imaging may provide more sensitive evaluation of the presence and severity of RP. In this case, uptake on during-RT imaging predated, predicted, and confirmed development of grade 1 RP at 3 months. Figure 1



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