Chest
Volume 143, Issue 1, January 2013, Pages 130-137
Journal home page for Chest

Original Research
Lung Cancer
Reassessment of Declines in Pulmonary Function ≥ 1 Year After Stereotactic Body Radiotherapy

https://doi.org/10.1378/chest.12-0207Get rights and content

Background

Stereotactic body radiation therapy (SBRT) is standard care for patients with inoperable early-stage non-small cell lung cancer. However, clinicians may hesitate to use SBRT in patients with severe COPD because of potential negative effects on pulmonary function. We quantitatively analyzed long-term declines in pulmonary function after SBRT to ascertain lifelong tolerability to SBRT.

Methods

Between 2005 and 2010 at Ofuna Chuo Hospital, 292 patients with lung tumors were treated with SBRT. Among them, patients who underwent pulmonary function tests (PFTs) both pretreatment and at ≥ 1 year after SBRT were evaluated in this retrospective analysis. The decline ratio in FEV1 and FVC was assessed (ie, ΔFEV1/preFEV1 and ΔFVC/preFVC). Predictors were identified using univariate and multivariate analyses.

Results

The 141 eligible patients had follow-up PFTs at a median of 21.0 (range, 12.0-74.8) months after SBRT. Among groups with normal function, or mild to moderate or severe COPD, the median values for ΔFEV1/preFEV1 were 7.9%, 7.9%, and 7.4%, respectively, and for ΔFVC/preFVC, 5.1%, 3.4%, and 0.5%, respectively. Low BMI was the only predictor for ΔFEV1/preFEV1 > 10%. Low BMI, high lung volume receiving ≥ 20 Gy, and high pretreatment FVC were predictors for ΔFVC/preFVC > 10%.

Conclusions

Declines in FEV1 and FVC were small, but statistically significant in patients with normal function or mild to moderate COPD, but nonsignificant in patients with severe COPD. These declines were primarily due to physiologic aging. SBRT had a limited effect on decline in long-term pulmonary function and may be an acceptable alternative to surgery for patients with comorbid lung cancer and COPD.

Section snippets

Patients

We retrospectively identified consecutive patients with localized primary lung cancer or solitary metastatic lung tumors treated with SRBT at Ofuna Chuo Hospital between February 2005 and September 2010. A total of 292 patients with 313 lung tumors were identified. Of these 292 patients, 19 had two metachronous lesions and one had three metachronous lesions; all lesions were treated with SBRT at different times. All patients received pretreatment PFTs. In November 2010, to assess long-term

Results

Among the 292 patients treated with SBRT, 184 patients were alive at November 2010 when posttreatment pulmonary function testing was initiated (Fig 1). Among these 184 patients, 142 underwent follow-up PFT at ≥ 1 year after SBRT. The other patients had either concluded follow-up prior to initiation of posttreatment PFT (November 2010), had died within 1 year after SBRT, were lost to follow-up or followed up only by telephone contact, or had experienced local recurrence or a second lung cancer.

Declines in Pulmonary Function Parameters Following SBRT

In this study, the most important implication is that declines in FEV1 and FVC after SBRT, even for patients with GOLD III-IV, were small after a median posttreatment duration of 21 months (range, 12.0-74.8 months). The median ΔFEV1/preFEV1 and ΔFVC/preFVC in patients with GOLD III-IV were 7.4% and 3.6%, respectively. The median, 25th percentile, and 75th percentile in ΔFEV1/preFEV1 and ΔFVC/preFVC in patients with GOLD III-IV were similar to those in patients with NPF or GOLD I-II (Fig 3).

Acknowledgments

Author contributions: Dr Takeda is guarantor of the manuscript and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Takeda: contributed to designing the search strategy; data abstraction, analysis, and interpretation; drafting the manuscript; revising the manuscript critically for important intellectual content; approving the final version of the manuscript; and served as principal author.

Dr Enomoto: contributed to data abstraction, analysis, and

References (24)

  • RI Harik-Khan et al.

    Body mass index and the risk of COPD

    Chest

    (2002)
  • GM Videtic et al.

    The role of stereotactic body radiotherapy in the management of non-small cell lung cancer: an emerging standard for the medically inoperable patient?

    Curr Oncol Rep

    (2010)
  • Cited by (34)

    • Management of Oligometastatic Colorectal Cancer

      2023, Surgical Clinics of North America
    • Pulmonary function after lung tumor stereotactic ablative radiotherapy depends on regional ventilation within irradiated lung

      2017, Radiotherapy and Oncology
      Citation Excerpt :

      Investigation of pulmonary function changes after lung tumor SABR has primarily emphasized the small significant or non-significant PFT changes from baseline that occur during follow-up. The safety and low observed toxicity following lung tumor SABR in patients with poor pulmonary reserve is necessary to provide a viable alternative treatment for non-operable candidates with early-stage NSCLC [31]. Quality of life after lung tumor SABR has been reported as stable for the majority of patients [37].

    View all citing articles on Scopus

    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    View full text