Prospective Evaluation of Novel 4DCT-Ventilation Imaging for Preoperative Risk Assessment in Lung Cancer: Results of the LIME Trial.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 42532440.
- Also identified by DOI 10.1016/j.ijrobp.2026.07.035.
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Abstract
Surgery is the primary treatment for early-stage lung cancer. Patients with poor preoperative lung function are at increased risk of pulmonary complications after anatomic lung resection. Surgeons determine candidacy for lung resection using pulmonary function tests (PFTs), calculating predicted postoperative PFTs (PPO PFTs) by estimating the volume of lung to be resected. Conventional PPO PFT calculations assume homogeneous lung function, which can be inaccurate. 4DCT-ventilation is a novel imaging modality developed in radiation oncology that uses 4DCT data to calculate lung function maps. This study reports the primary outcomes of the XXX (Anonymized for Review) trial, a prospective clinical trial comparing 4DCT-ventilation-based PPO PFTs to conventionally measured postoperative lung function. The trial enrolled patients with stage I-IIIa lung cancer undergoing evaluation for anatomic lung resection. Patients underwent PFTs and 4DCT imaging before and 3 months after surgery. Validated image processing techniques generated 4DCT-ventilation images using the preoperative 4DCT. We calculated 4DCT-ventilation-based PPO PFTs by scaling preoperative PFTs by the 4DCT-ventilation in the surgical volume and conventional PPO PFTs following standard-of-care methods. Concordance-correlation-coefficients (CCCs) compared PPO PFTs to postoperative PFTs for 3 PFT measures: Forced Expiratory Volume in the first second (FEV<sub>1</sub>), Forced Vital Capacity (FVC), and Diffusing Capacity of the Lungs for Carbon Monoxide (DL<sub>CO</sub>). The primary hypothesis was a CCC ≥ 85% for 4DCT-ventilation-based predictions. From 2018 to 2021, 65 patients consented to the study, with 36 considered evaluable. The 4DCT-ventilation-based CCCs were 91% (FEV<sub>1</sub>), 89% (FVC), and 88% (DL<sub>CO</sub>), meeting the primary endpoint. Conventional CCCs were comparable, although 4DCT appeared to perform better than the conventional approach in patients with heterogeneous lung function. The trial met the primary endpoint with accurate 4DCT-ventilation-based prediction. The data support further investigation in an interventional trial using 4DCT-ventilation to prospectively guide surgical decision-making in lung cancer treatment.