Accounting for Serial and Parallel Functionality of the Lung May Minimize Post-Radiotherapy Loss of Respiratory Function in Lung Cancer Patients

Abstract

Functional lung avoidance (FLA) radiotherapy (RT) aims to minimize post-RT respiratory function loss. Current FLA approaches spatially map lung function and preferentially avoid dose to high-functioning lung (HFL). However, current FLA methods do not adequately consider the conducting architecture responsible for gas exchange (airways/vasculature). Previously, we showed that excessive toxicity to airways results in airway collapse, leading to functional loss within downstream lung sub-volumes. We proposed the functionally weighted airway sparing (FWAS) method to spare airways connected to HFL. Here, we propose a novel method that combines both FLA and FWAS to minimize post-RT functional loss.