Lung Function After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer, Changes and Predictive Markers

Janna Berg; Christina Ramberg; Jon Olav Sulheim Haugstvedt; May-Bente Bengtson; Anne-Marie Gabrielsen; Odd Terje Brustugun; Ann Rita Halvorsen; Åslaug Helland

doi:10.3389/fonc.2021.674731

Lung Function After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer, Changes and Predictive Markers

Front Oncol. 2021 May 24:11:674731. doi: 10.3389/fonc.2021.674731. eCollection 2021.

Authors

Janna Berg^{1

2}, Christina Ramberg³, Jon Olav Sulheim Haugstvedt⁴, May-Bente Bengtson¹, Anne-Marie Gabrielsen¹, Odd Terje Brustugun^{2

5}, Ann Rita Halvorsen^{6

7}, Åslaug Helland^{2

6

7}

Affiliations

¹ Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway.
² Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
³ Department of Medical Physics, Oslo University Hospital, Oslo, Norway.
⁴ Department of Radiology and Nuclear Medicine, Vestfold Hospital Trust, Tønsberg, Norway.
⁵ Section of Oncology, Vestre Viken Hospital Trust, Drammen, Norway.
⁶ Department of Oncology, Oslo University Hospital, Oslo, Norway.
⁷ Department of Clinical Medicine, University of Oslo, Oslo, Norway.

Abstract

Introduction: The present study explores changes in pulmonary function, symptoms and radiological signs of pneumonitis after curatively intended stereotactic body radiation therapy (SBRT).

Methods: All inoperable, early-stage non-small cell lung cancer patients treated with stereotactic body radiation therapy (SBRT) from 2014-2017 were included in this single-centre study. They were followed regularly for 12 months after treatment. The patients were classified into three groups based on radiology and symptomatology: no radiation pneumonitis, asymptomatic and symptomatic radiation pneumonitis.

Results: Forty-four patients with stage IA-IIB disease were treated with 45-56 Gy in 3-8 fractions. The median age was 75 years, 43% of the patients were female; 60% of the patients had a COPD in GOLD grade of 2-4, and 95.5% were active or former smokers. Symptomatic radiation pneumonitis occurred in 18% of the patients and asymptomatic pneumonitis as defined by radiology, in 39%. The mean of forced expiratory volume in 1 second (FEV1) and diffusion capacity for carbon monoxide (DLCO) decreases for all patients during the first years were higher than one would expect from physiologic ageing. FEV1 and DLCO in percent decrease 7-8% at 1-1.5 months in the symptomatic radiation pneumonitis group. CT scan findings consistent with radiation pneumonitis occurred after a median of 2.9 months in the symptomatic and 5.4 months in the asymptomatic radiation pneumonitis groups. In the group with symptomatic radiation pneumonitis, symptoms, as measured by the Clinical COPD questionnaire score, significantly increased at 3 and 6 months. Significant higher maximum doses to the critical lung volumes DC1000cm³ (1000 cm³ of lung receiving a given dose or less) and DC 1500cm³ (1500 cm³ of lung receiving a given dose or less) were observed in patients who developed radiation pneumonitis.

Conclusion: Early decrease in measured FEV1 and DLCO occurred before imaging changes and symptoms and might indicate the development of symptomatic radiation pneumonitis. The dose to critical lung volumes of DC1000 cm³ and DC1500 cm³ may predict the risk for the development of symptomatic radiation pneumonitis.

Keywords: non-small cell lung cancer (NSCLC); pulmonary function test; radiation pneumonitis; radiotherapy dose-volume; stereotactic body radiation therapy (SBRT); toxicity.