{ "abstract": "Background\n\nRadiation therapy (RT) is indicated for 77% of patients with lung cancer. Over 20% of patients are affected by radiation-induced lung injury. Computed tomography ventilation imaging (CTVI) estimates high and low functioning lung regions. During RT planning, CTVI can guide preferential avoidance of higher ventilated regions by redirecting dose to less well ventilated regions, sparing healthy lung tissue. The double-masked randomized Trans-Tasman Radiation Oncology Group (TROG) 21.08 VITaL trial will investigate if sparing healthy lung can improve the quality of life (QoL) for patients with stage 3 non-small cell lung cancer (NSCLC) treated with RT.Methods\n\n165 patients will be recruited to test the hypothesis that patients receiving healthy lung-sparing RT have better QoL than patients receiving standard RT. CTVI will be generated from exhale and inhale breath-hold CT scan pairs. A healthy lung-sparing plan and a standard treatment plan will be created for each patient and randomly assigned in a 1:1 ratio for the patient's treatment. QoL will be assessed with the Functional Assessment of Cancer Therapy-Lung questionnaire before and after treatment. Secondary hypotheses include that patients in the healthy lung-sparing arm will have fewer treatment side effects, better lung function, be more likely to receive and complete adjuvant immunotherapy, and healthy lung-sparing treatment will be cost-effective. Patient follow-up will continue for three years.Discussion\n\nThis prospective randomized trial will determine whether the incorporation of healthy lung-sparing RT based on CTVI improves QoL, reduces pulmonary toxicity, and increases eligibility to receive curative immunotherapy for patients with stage 3 NSCLC.Trial registration\n\nClinicalTrials.gov (NCT06127654).", "abstract_shown": true, "affiliations": [ "Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia.", "South West Sydney Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.", "Sydney School of Public Medicine & Health, University of Sydney, Sydney, NSW, Australia.", "Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.", "Sydney Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.", "Alfred Health Radiation Oncology, Melbourne, VIC, Australia.", "Central Clinical School, Monash University, Melbourne, VIC, Australia.", "Austin Health, Melbourne, VIC, Australia.", "Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia.", "Genesis Care, Sydney, NSW, Australia.", "Sydney Medical School, University of Sydney, Sydney, NSW, Australia.", "Verspeeten Family Cancer Centre, London Health Sciences Centre, London, Ontario, Canada.", "Division of Radiation Oncology, Western University, London, Canada.", "Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.", "Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.", "Image X Institute, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.", "Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia.", "School of Information and Physical Sciences, The University of Newcastle, Newcastle, NSW, Australia.", "Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.", "POLARIS, Section of Medical Imaging and Technologies, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom.", "Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom.", "Thoracic Oncology Group of Australasia, Thornbury VIC, Australia.", "Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.", "Cancer Voices NSW, Milsons Point, NSW, Australia.", "Department of Medical Oncology, Monash Health, Melbourne, VIC, Australia.", "School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.", "4DMedical, Melbourne, VIC, Australia.", "Trans-Tasman Radiation Oncology Group, Waratah, NSW, Australia." ], "article_type": "research article", "arxiv": null, "author_total": 26, "authors": [ { "affs": [ 0, 1, 2, 3 ], "name": "Shalini K Vino D" }, { "affs": [ 4 ], "name": "Val Gebski" }, { "affs": [ 5, 6 ], "name": "Sashendra Senthi" }, { "affs": [ 7 ], "name": "Cynleen Kai" }, { "affs": [ 8, 9, 10 ], "name": "Dasantha Jayamanne" }, { "affs": [ 11, 12 ], "name": "David Palma" }, { "affs": [ 13, 14 ], "name": "Nicholas Hardcastle" }, { "affs": [ 9, 15 ], "name": "Hilary L Byrne" }, { "affs": [ 11, 12 ], "name": "Douglas A Hoover" }, { "affs": [ 8, 15 ], "name": "John Kipritidis" }, { "affs": [ 0 ], "name": "Anthony Espinoza" }, { "affs": [ 16, 17 ], "name": "Benjamin Zwan" }, { "affs": [ 9, 15 ], "name": "Guneet Kaur" }, { "affs": [ 18 ], "name": "Amit Sawant" }, { "affs": [ 19, 20 ], "name": "Bilal A Tahir" }, { "affs": [ 4 ], "name": "Rebecca Mercieca-Bebber" }, { "affs": [ 4 ], "name": "Karan K Shah", "orcid": "0000-0002-9838-0894" }, { "affs": [ 21 ], "name": "Andrew Bowen" }, { "affs": [ 22 ], "name": "Miriam Cavanagh" }, { "affs": [ 23 ], "name": "Lee Hunt" }, { "affs": [ 24, 25 ], "name": "Surein Arulananda" }, { "affs": [ 15 ], "name": "Helen Ball" }, { "affs": [ 26 ], "name": "Nina Eikelis" }, { "affs": [ 27 ], "name": "Alisha Moore" }, { "affs": [ 15 ], "name": "Shona Silvester" }, { "affs": [ 15 ], "name": "Paul Keall" } ], "bibtex": "https://research.draconitic.com/paper/ehe1pnb0n4gm1.bib", "cited_by": 0, "doi": "10.1016/j.ctro.2026.101312", "fulltext_url": "https://europepmc.org/articles/PMC13684938", "id": "ehe1pnb0n4gm1", "issns": [ "2405-6308" ], "landing_url": "https://europepmc.org/article/MED/42910049", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "3108|Advanced Radiotherapy Techniques" ] ], "openalex": "W7221054306", "pdf_url": "https://europepmc.org/articles/PMC13684938?pdf=render", "pmcid": "PMC13684938", "pmid": "42910049", "published": "2026-10-08", "publisher": null, "ris": "https://research.draconitic.com/paper/ehe1pnb0n4gm1.ris", "sources": [ { "first_seen": "2026-10-30T12:20:10Z", "native_id": "MED:42910049", "source": "europepmc", "url": "https://europepmc.org/article/MED/42910049" } ], "subjects": [ { "field": "physics", "origin": "openalex:3108|Advanced Radiotherapy Techniques", "subfield": "applied-instrumentation" } ], "title": "Study protocol for the TROG 21.08 VITaL trial: a randomized controlled trial investigating ventilation imaging to improve the quality of life for patients with lung cancer treated with radiation therapy.", "title_text": "Study protocol for the TROG 21.08 VITaL trial: a randomized controlled trial investigating ventilation imaging to improve the quality of life for patients with lung cancer treated with radiation therapy.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:20:10Z", "url": "https://research.draconitic.com/paper/ehe1pnb0n4gm1", "venue": "Clinical and translational radiation oncology", "versions": [] }