Ran Takenaka1, Yuta Shibamoto2, Akifumi Miyakawa3, Chisa Hashizume4, Fumiya Baba5. 1. Department of Radiology, Narita Memorial Hospital, Toyohashi, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: ran715@gmail.com. 2. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 3. Department of Radiation Oncology, Nanbu Tokushukai General Hospital, Yaese, Okinawa, Japan. 4. Radiosurgery Center, Nagoya Kyoritu Hospital, Nagoya, Japan. 5. Nagoya City West Medical Center, Nagoya, Japan.
Abstract
BACKGROUND: After stereotactic body radiotherapy (SBRT) to the lung, radiation pneumonitis and fibrotic changes often develop, and the tumor shadow usually becomes indistinguishable from the fibrotic shadow. Occasionally, however, a residual mass in patients with no or mild radiation pneumonitis will be observed on serial computed tomography (CT) scans. The purpose of the present study was to evaluate the fate of such residual masses and, if possible, to determine the types of tumor at increased risk of local recurrence. PATIENTS AND METHODS: A total of 50 patients (underlying disease: primary lung cancer in 45, local recurrence in 2, and metastasis in 3) were selected because they had been followed up for > 2 years or until death and had observable CT changes and measurable tumor size for > 1 year, regardless of the influence of radiation pneumonitis. The patients' outcomes were compared according to various patient and tumor characteristics, including the presence and absence of emphysema, tumor size, and tumor shrinkage rate. The median follow-up period was 52 months. RESULTS: Of the 50 patients, only 8 developed local recurrence. The local control rate was 81% at 3 years and 73% at 5 years. The local control rates were similar between patients with a high tumor shrinkage rate and those with a low rate. The patients with emphysema exhibited a lower local control rate. CONCLUSION: The persistence of lung masses for > 1 year after SBRT is not necessarily indicative of an increased risk of local recurrence. A low tumor shrinkage rate also was not predictive of recurrence.
BACKGROUND: After stereotactic body radiotherapy (SBRT) to the lung, radiation pneumonitis and fibrotic changes often develop, and the tumor shadow usually becomes indistinguishable from the fibrotic shadow. Occasionally, however, a residual mass in patients with no or mild radiation pneumonitis will be observed on serial computed tomography (CT) scans. The purpose of the present study was to evaluate the fate of such residual masses and, if possible, to determine the types of tumor at increased risk of local recurrence. PATIENTS AND METHODS: A total of 50 patients (underlying disease: primary lung cancer in 45, local recurrence in 2, and metastasis in 3) were selected because they had been followed up for > 2 years or until death and had observable CT changes and measurable tumor size for > 1 year, regardless of the influence of radiation pneumonitis. The patients' outcomes were compared according to various patient and tumor characteristics, including the presence and absence of emphysema, tumor size, and tumor shrinkage rate. The median follow-up period was 52 months. RESULTS: Of the 50 patients, only 8 developed local recurrence. The local control rate was 81% at 3 years and 73% at 5 years. The local control rates were similar between patients with a high tumor shrinkage rate and those with a low rate. The patients with emphysema exhibited a lower local control rate. CONCLUSION: The persistence of lung masses for > 1 year after SBRT is not necessarily indicative of an increased risk of local recurrence. A low tumor shrinkage rate also was not predictive of recurrence.