Prospective Evaluation of Novel 4DCT-Ventilation Imaging for Preoperative Risk Assessment in Lung Cancer: Results of the LIME Trial

PURPOSE: 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. METHODS: ). The primary hypothesis was a CCC ≥ 85% for 4DCT-ventilation-based predictions. RESULTS: ), meeting the primary endpoint. Conventional CCCs were comparable, although 4DCT appeared to perform better than the conventional approach in patients with heterogeneous lung function. CONCLUSION: 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.