Tumor Volume as a Potential Imaging-Based Risk-Stratification Factor in Trimodality Therapy for Locally Advanced Non-small Cell Lung Cancer Margaret.

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Tumor Volume as a Potential Imaging-Based Risk-Stratification Factor in Trimodality Therapy for Locally Advanced Non-small Cell Lung Cancer Margaret M. Kozak, BS, James D. Murphy, MD, MS, Meike L. Schipper, MD, Jessica S. Donington, MD, Lisa Zhou, PhD, Richard I. Whyte, MD, MBA, Joseph B. Shrager, MD, Chuong D. Hoang, MD, Jose Bazan, MD, Peter G. Maxim, PhD, Edward E. Graves, PhD, Maximilian Diehn, MD, PhD, Wendy Y. Hara, MD, Andrew Quon, MD, Quynh-Thu Le, MD, Heather A. Wakelee, MD, Billy W. Loo, MD, PhD Journal of Thoracic Oncology Volume 6, Issue 5, Pages 920-926 (May 2011) DOI: 10.1097/JTO.0b013e31821517db Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Volumetric response to preoperative chemoradiotherapy (CRT) in a patient with stage IIIA non-small cell lung cancer (NSCLC; patient 8). A, a representative axial, saggital, and coronal cut through the gross tumor volume (GTV), including primary and nodal disease, outlined in red. The contours were manually delineated as part of the radiation planning process. B, substantial (60%) volume reduction in the GTV after CRT (45 Gy). The post-CRT contours (red) were generated from the pre-CRT contours using automatic deformable image registration (ADIR). Only minimal further manual editing was required to produce the final post-CRT contours. Journal of Thoracic Oncology 2011 6, 920-926DOI: (10.1097/JTO.0b013e31821517db) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Comparison of pre- and postchemoradiotherapy (CRT) tumor volumes (total, primary, and nodal). Solid line: regression line for total tumor volume. The high correlation indicates a consistent response to CRT of approximately 40% volume reduction. Dotted line: identity line corresponding to no volumetric response. Vertical and horizontal dashed lines: median values of pre- and post-CRT total tumor volumes, respectively, each of which divide the patient cohort into the same two subgroups. Journal of Thoracic Oncology 2011 6, 920-926DOI: (10.1097/JTO.0b013e31821517db) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Comparison of postchemoradiotherapy (CRT) tumor volumes (total, primary, and nodal) determined by manual editing versus automatic deformable image registration (ADIR). Solid line: regression line for total tumor volume. Dotted line: identity line corresponding to perfect agreement. The high correlation and slope of near unity indicate good agreement between ADIR and manually edited volumes (the gold standard), but the offset indicates a slight consistent overestimation by ADIR of approximately 13 ml. Vertical and horizontal dashed lines: median values of manual and ADIR total tumor volumes, respectively, each of which divide the patient cohort into the same two subgroups. Journal of Thoracic Oncology 2011 6, 920-926DOI: (10.1097/JTO.0b013e31821517db) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 When stratified by the median value of total tumor volume (whether prechemoradiotherapy [CRT] or post-CRT determined by either manual editing or automatic deformable image registration [ADIR]), patients with lower tumor volume had significantly improved progression-free survival (PFS), and a statistically insignificant trend toward improved overall survival. A, PFS by tumor volume. B, Overall survival (OS) by tumor volume. Journal of Thoracic Oncology 2011 6, 920-926DOI: (10.1097/JTO.0b013e31821517db) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions