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Difference in failure patterns after stereotactic body radiotherapy for lung cancer according to clinical T stage based on 4D computed tomography

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Abstract

Purpose

Stereotactic body radiotherapy (SBRT) is a treatment option for early-stage lung cancer. We aimed to examine the differences in failure patterns after SBRT according to the clinical T stage.

Methods

A total of 120 patients with early-stage lung cancer (T1-3N0M0) who underwent SBRT were analysed. The clinical stage in patients whose tumours were in contact with the chest wall was confirmed using four-dimensional computed tomography (4D-CT). Local failure, regional node metastasis, and distant metastasis were confirmed from clinical charts.

Results

Median follow-up time was 27.5 months (range 7–122) after SBRT. Thirteen patients were restaged from clinical T2 with visceral pleural invasion to T3 with chest wall invasion using 4D-CT analysis. Thirty-seven patients developed recurrences. The median progression-free survival (PFS) and overall survival (OS) were 38.1 and 53.8 months, respectively. The 3‑year PFS and OS rates were 50.7% and 60.3%, respectively. A significant difference was observed in PFS according to the clinical T stage (p = 0.001). No significant differences were observed in OS according to the clinical T stage (p = 0.213). The proportion of locoregional failures relative to distant metastasis decreased with progression from T1 to T3. The pleural dissemination rate was significantly higher in T3 tumours than in T1 and T2 tumours (p = 0.010).

Conclusion

Clinical T stage is associated with PFS after SBRT for lung cancer. There were differences in the failure patterns according to T stage. 4D-CT might provide significant information for assessing chest wall invasion associated with unfavourable PFS.

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Acknowledgements

We thank Mr. Kenji Matsumoto from the Department of Central Radiology, Kindai University Hospital.

Funding

This work was supported by JSPS KAKENHI (grant number JP20K08093).

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Authors and Affiliations

  1. Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan

    Takaya Inagaki, Hiroshi Doi MD PhD, Masahiro Inada, Naoko Ishida, Aritoshi Ri, Saori Tatsuno, Yutaro Wada, Takuya Uehara, Kiyoshi Nakamatsu, Makoto Hosono & Yasumasa Nishimura

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  1. Takaya Inagaki
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  2. Hiroshi Doi MD PhD
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  3. Masahiro Inada
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Contributions

TI and HD conceived this study, analysed the data and drafted the manuscript. TI, HD, MI, NI, AR, ST, YW, TU, KN, MH and YN performed radiotherapy. TI and MI collected the data. YN supervised the project. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hiroshi Doi MD PhD.

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Conflict of interest

T. Inagaki, H. Doi, M. Inada, N. Ishida, A. Ri, S. Tatsuno, Y. Wada, T. Uehara, K. Nakamatsu, M. Hosono and Y. Nishimura declare that they have no competing interests.

Ethical standards

This study was conducted in accordance with the guidelines of the Declaration of Helsinki. This study was approved by our institutional review board (approval number R03-116). Consent to participate: Written informed consent for radiotherapy was obtained from all individual participants prior to radiotherapy. Informed consent for this study was obtained in the form of opt-out. Consent to publish: Not applicable.

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Data availability

The data are available from the corresponding author upon reasonable request.

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Inagaki, T., Doi, H., Inada, M. et al. Difference in failure patterns after stereotactic body radiotherapy for lung cancer according to clinical T stage based on 4D computed tomography. Strahlenther Onkol 199, 465–476 (2023). https://doi.org/10.1007/s00066-022-02030-0

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