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Factors associated with cavity formation after stereotactic body radiation therapy for peripheral early-stage lung cancer

  • Radiotherapy
  • Published:
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Abstract

Purpose

This retrospective study aimed to identify the factors associated with cavity formation after SBRT in peripheral early-stage lung cancer patients. We analyzed the occurrence of cavity changes after SBRT.

Materials and Methods

We examined 99 cases with T1-T2aN0 peripheral non-small cell lung cancer treated with SBRT from 2004 to 2021. Patients underwent respiratory function tests, including diffusing capacity for carbon monoxide (DLco), before treatment. The median observation period was 35 months (IQR 18–47.5 months). Treatment involved fixed multi-portal irradiation in 67% of cases and VMAT in 33%. The total radiation doses ranged from 42 to 55 Gy, delivered over 4 to 5 fractions.

Results

Cavity formation occurred in 14 cases (14.1%), appearing a median of 8 months after SBRT. The cavity disappeared in a median of 4 months after formation. High DLco and total radiation dose were identified as factors significantly associated with cavity formation. There have been no confirmed recurrences to date, but one patient developed a lung abscess.

Conclusion

Although cavity formation after SBRT for peripheral early-stage lung cancer is infrequent, it can occur. This study showed high DLco and total radiation dose to be factors significantly associated with cavity formation. These findings can be applied to optimizing radiation therapy (RT) and improving patient outcomes. Further research is needed to determine the optimal radiation dose for patients with near-normal DLco for whom surgery is an option. This study provides valuable insights into image changes after RT.

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Abbreviations

SBRT:

Stereotactic body radiation therapy

DLco:

Diffusing capacity for carbon monoxide

IQR:

Interquartile range

VC:

Vital capacity

FEV1.0:

Forced expiratory volume during the first second

CTV:

Clinical target volume

ITV:

Internal target volume

PTV:

Planning target volume

JCOG:

Japan clinical oncology group

VMAT:

Volumetric modulated arc therapy

BED:

Biologically effective dose

UL:

Upper lobe

LL:

Lower lobe

ML:

Middle lobe

PS:

Performance status

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-Cho, Itabashi-Ku, Tokyo, 173-8610, Japan

    Toshiya Maebayashi, Masakuni Sakaguchi, Takuya Aizawa & Akahiko Sato

  2. Department of Radiology, Nihon University Hospital, Chiyoda-Ku, Tokyo, 101-8309, Japan

    Naoya Ishibashi

  3. Radiology Clinic, Sonoda Medical Hospital, Adachi-Ku, Tokyo, 121-0064, Japan

    Tsutomu Saito

  4. Department of Radiation Oncology, St. Luke’s International Hospital, Chuo-Ku, Tokyo, 121-0064, Japan

    Jiro Kawamori

  5. Department of Radiology, Kasukabe Medical Center, Kasukabe, Saitama, 344-8588, Japan

    Yoshiaki Tanaka

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Toshiaya Maebayashi, Akahiko Sato, Takuya Aizawa, Masakuni Sakaguchi and Naoya Ishibashi. The first draft of the manuscript was written by Toshiya Maebayashi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Toshiya Maebayashi.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board of Nihon University School of Medicine, and informed consent was obtained from all participating patients (Trial registration number: Nihon University Itabashi Hospital Clinical Research Center RK-190611–3).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Written informed consent was obtained from each patient for all diagnostic tests and treatments, as well as for publication of this report and accompanying images. A copy of the written consent form is available for review by the Editor-in-Chief of the journal.

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Written informed consent was obtained from each patient for all diagnostic tests and treatments, as well as for publication of this report and accompanying images. A copy of the written consent form is available for review by the Editor-in-Chief of the journal.

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Maebayashi, T., Ishibashi, N., Sakaguchi, M. et al. Factors associated with cavity formation after stereotactic body radiation therapy for peripheral early-stage lung cancer. Radiol med 129, 507–514 (2024). https://doi.org/10.1007/s11547-024-01766-2

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