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Volumetric Modulated Arc Therapy planning and treatment delivery to treat primary and nodal planning target volume with 60 Gy in 30 fractions and a simultaneous integrated boost to the primary tumour to a total dose 69Gy in 30 fractions while avoiding organs at risk including functional lung, heart and oesophagus.

Functionally adapted, dose escalated VMAT radiotherapy

Nicholas W Bucknell, MBBS (hons)

This study is being performed to assess the feasibility of adapting radiotherapy plans based on functional lung information and increasing the dose to the primary tumour. This is a single arm interventional pilot study involving 20 patients.

Aims Primary: to assess the feasibility of using ventilation and perfusion positron emission computed tomography (V/Q PET/CT) scans to adapt radiotherapy plans using Volumetric Modulated Arc Therapy (VMAT) to avoid regions of functional lung and deliver a higher dose to the primary tumour Secondary: to assess the incidence of acute and late radiotherapy toxicities, to quantify regional ventilation loss and regional perfusion loss on post treatment V/Q PET/CT, to assess associations of V/Q PET/CT with other functional lung imaging techniques, to assess overall survival, progression free survival and quality of life outcomes.

Participants: 20 patients stage IIIa-c non-small cell lung cancer for curative intent radiotherapy.

Methods: All patients will receive functional lung adapted 60 Gray (Gy) in 30 fractions to the primary and nodal planning target volume with a simultaneous integrated boost to the primary tumour to a total dose 69Gy in 30 fractions.

Expected outcomes: That functionally adapted lung radiotherapy using V/Q PET/CT imaging and VMAT planning is technically feasible.

High Intensity Functional Image Guided Vmat Lung Evasion

To assess the technical feasibility of the delivery of personalised functional lung radiotherapy.

To determine the incidence of grade ≥ 2 clinical or radiological pneumonitis after high dose functionally adapted radiotherapy

To quantify regional ventilation loss on post treatment ventilation PET/CT following functionally adapted lung radiotherapy. Measures will use the end-inspiratory and end-expiratory volume for each lung and lobe. Assessed on V PET/CT imaging from baseline to 3 months post treatment and from baseline to 12 months.

To quantify regional perfusion loss on post treatment ventilation PET/CT following functionally adapted lung radiotherapy. Measures will use the end-inspiratory and end-expiratory volume for each lung and lobe. Assessed on Q PET/CT imaging from baseline to 3 months post treatment and from baseline to 12 months

To assess the associations between ventilation PET/CT with inhale/exhale CT ventilation. This will be compared on imaging at baseline, 3 months post treatment and 12 month post treatment.

To assess the associations between perfusion PET/CT with dual energy CT iodine mapping ventilation (DECT iodine mapping is regarded as a surrogate for pulmonary perfusion). This will be compared on imaging at baseline, 3 months post treatment and 12 month post treatment.

This will be assessed by pre, 3 and 12 month post treatment transthoracic echocardiograms and ECG investigations.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
High Intensity Functional Image Guided Vmat Lung Evasion	NCT03569072	Non Small Cell ...	Functionally ad...	18 Years -	Peter MacCallum Cancer Centre, Australia
High Intensity Functional Image Guided Vmat Lung Evasion	NCT03569072	Non Small Cell ...	Functionally ad...	18 Years -	Peter MacCallum Cancer Centre, Australia
High Intensity Functional Image Guided Vmat Lung Evasion	NCT03569072	Non Small Cell ...	Functionally ad...	18 Years -	Peter MacCallum Cancer Centre, Australia

Spots Global Cancer Trial Database for functionally adapted, dose escalated vmat radiotherapy