Abstract
Pretreatment pulmonary interstitial change (PIC) has been indicated as a risk factor of severe radiation pneumonitis (RP) following stereotactic body radiation therapy (SBRT) for early-stage lung cancer, but details of its true effect remain unclear. This study aims to evaluate treatment outcomes of SBRT for stage I non-small cell lung cancer in patients with PIC. A total of 242 patients are included in this study (88% male). The median age is 77 years (range, 55–92 years). A total dose of 40–70 Gy is administered in 4 to 10 fractions during a 4-to-25 day period. One, two, and three-year overall survival (OS) rates are 82.1%, 57.1%, and 42.6%, respectively. Fatal RP is identified in 6.9% of all patients. The percent vital capacity <70%, mean percentage normal lung volume receiving more than 20 Gy (>10%), performance status of 2–4, presence of squamous cell carcinoma, clinical T2 stage, regular use of steroid before SBRT, and percentage predicting forced expiratory volume in one second (<70%) are associated with worse prognoses for OS. Our results indicate that fatal RP frequently occurs after SBRT for stage I lung cancer in patients with PIC.
Highlights
Hypofractionated stereotactic body radiation therapy (SBRT) delivers a high-dose concentration to tumor with limited toxicity to normal structures
Reported a high incidence of fatal radiation pneumonitis (RP) (3 of 25 patients) after SBRT, which occurred in patients with poor respiratory function, interstitial pneumonitis (IP), and recurrence after surgery
In regard to the incidence of severe RP, the fact that V20 more than 10% was the most outstanding risk factor in the current study indicated that a larger irradiated volume would be a major risk factor
Summary
Hypofractionated stereotactic body radiation therapy (SBRT) delivers a high-dose concentration to tumor with limited toxicity to normal structures. Due to this advantage, SBRT is commonly performed in patients with small-sized primary or oligometastatic lung tumors as a radical and minimally invasive treatment; it is utilized in patients who are medically inoperable due to poor pulmonary function with chronic lung disease. The purpose of this study was to evaluate the treatment outcomes and determine risk factors for fatal RP after SBRT for stage I NSCLC in patients with PIC in a large database of a Japanese multi-institutional study group
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