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Original Research

Open Access Special Issue

Precision radiotherapy by SPECT lung functional imaging in NSCLC

  • Carlo Greco1
  • Michele Fiore1,*,
  • Venanzio Valenza2
  • Cristina Di Venanzio1
  • Guido Rovera2
  • Edy Ippolito1
  • Mariella Zollino2
  • Rolando Maria D’Angelillo3
  • Alessandro Giordano2
  • Sara Ramella1

1Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy

2Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy

3Radioterapia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy

DOI: 10.31083/j.jomh1804101 Vol.18,Issue 4,April 2022 pp.1-7

Submitted: 15 November 2021 Accepted: 13 January 2022

Published: 30 April 2022

(This article belongs to the Special Issue Lung Cancer: The Changing Paradigm)

*Corresponding Author(s): Michele Fiore E-mail:


Background: Single Photon Emission Computed Tomography (SPECT) could be used to avoid the non-affected perfusion areas in patients with non-small-cell lung cancer (NSCLC) and to potentially reduce lung toxicity. The aim of this study is to compare dosimetric differences between two different 3D-conformal treatment plans, with and without CT/SPECT contribution. Methods: Simulation Computed tomography (CT) scans were accurately co-registered with SPECT scans and three different areas, based on SPECT intensity perfusion, were contoured: low perfusion (LP), medium perfusion (MP) and high perfusion (HP). Two different 3D-conformal plans, with co-planar and nonco-planar fields, were generated; one without SPECT information (anatomic plan), and one using the perfusion area identified with functional imaging (functional plan). Results: 9 patients were planned and a total of 18 plans were available for analysis. Anatomical and functional plans resulted in comparable planning target volume (PTV) coverage. In the functional plans, a significant reduction of dose in high perfusion areas was reported. The reduction of HP-V20 Gy values ranged from 15% to 8% (p = 0.046), the ipsiHP-V20 Gy from 38% to 22% (p = 0.028) and ipsiHP-Dmean reduction from 16 Gy to 12 Gy (p = 0.039). No significant differences in other organs at risk (OARs) metrics were reported between anatomical and functional plans. Conclusions: Despite the few cases reported, the strength of our study lies in the reported benefit of functional lung information in 3D conformal radiation planning, without compromising target coverage or worsening dose distribution to the OARs. There is an urgent need for prospective clinical and randomized trials in order to define the role of lung functional imaging in reducing toxicity in clinical practice.


pecision medicine; functional imaging; NSCLC; radiotherapy

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Carlo Greco,Michele Fiore,Venanzio Valenza,Cristina Di Venanzio,Guido Rovera,Edy Ippolito,Mariella Zollino,Rolando Maria D’Angelillo,Alessandro Giordano,Sara Ramella. Precision radiotherapy by SPECT lung functional imaging in NSCLC. Journal of Men's Health. 2022. 18(4);1-7.


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