Quantifying changes in ventilation for photon- and proton-treated patients according to dose and pneumonitis development

Treatment of non-small cell lung cancer with proton therapy allows for delivery of high radiation dose while sparing critical normal tissue structures compared to conventional photon therapy. However, there are currently no established clinical endpoints to study the biological effect between these radiation modalities. Computed tomography (CT) imaging allows for extraction of ventilation through deformable image registration of 4DCTs and may provide information on imaging-based functional changes in the lung. We hypothesize that patients treated with protons exhibit different changes in ventilation compared to those treated with photons. For 20 photon and 20 proton cases, ventilation was extracted using 4DCT Jacobian-based methods and correlated with dose and radiation-induced pneumonitis development. Ventilation was tracked over the course of treatment on a voxel-wise basis and stratified into high and low function. Ventilation differences across modalities were compared by function and pneumonitis development. Patients treated with protons exhibited statistically significant improvements in ventilation change of low functioning voxels compared to photon patients. Future work will evaluate ventilation change specifically in the lung regions that developed pneumonitis.