Subpleural fibrotic interstitial lung abnormalities are implicated in non-small cell lung cancer radiotherapy outcomes

• Published in: Radiology and oncology Vol. 57; no. 2; pp. 229 - 238
• Main Authors: Ito, Makoto, Katano, Takuma, Okada, Hiroaki, Sakuragi, Ami, Minami, Yoshitaka, Abe, Souichiro, Adachi, Sou, Oshima, Yukihiko, Ohashi, Wataru, Kubo, Akihito, Fukui, Takayuki, Ito, Satoru, Suzuki, Kojiro
• Format: Journal Article
• Language: English
• Published: Poland Sciendo 01.06.2023; De Gruyter Poland
• Subjects: Abnormalities; Carcinoma, Non-Small-Cell Lung - complications; Fibrosis; Humans; interstitial lung abnormality; Lung; Lung cancer; Lung diseases; Lung Diseases, Interstitial - complications; Lung Diseases, Interstitial - epidemiology; Lung Neoplasms; Medical prognosis; Multivariate analysis; non-small cell lung cancer; Non-small cell lung carcinoma; Pneumonitis; Pulmonary fibrosis; Radiation; radiation pneumonitis; Radiation Pneumonitis - etiology; Radiation therapy; radiotherapy; Retrospective Studies; Risk factors; Small cell lung carcinoma; subpleural fibrosis; Survival; Survival analysis; non-small cell lung cancer; radiotherapy; subpleural fibrosis; interstitial lung abnormality; survival analysis; radiation pneumonitis
• ISSN: 1581-3207; 1318-2099; 1581-3207; 0485-893X
• DOI: 10.2478/raon-2023-0018

The relationship between interstitial lung abnormalities (ILAs) and the outcomes of lung cancer radiotherapy is unclear. This study investigated whether specific ILA subtypes are risk factors for radiation pneumonitis (RP). This retrospective study analysed patients with non-small cell lung cancer treated with radical-intent or salvage radiotherapy. Patients were categorised into normal (no abnormalities), ILA, and interstitial lung disease (ILD) groups. The ILA group was further subclassified into non-subpleural (NS), subpleural non-fibrotic (SNF), and subpleural fibrotic (SF) types. The Kaplan-Meier and Cox regression methods were used to determine RP and survival rates and compare these outcomes between groups, respectively. Overall, 175 patients (normal, n = 105; ILA-NS, n = 5; ILA-SNF, n = 28; ILA-SF, n = 31; ILD, n = 6) were enrolled. Grade ≥2 RP was observed in 71 (41%) patients. ILAs (hazard ratio [HR]: 2.33, p = 0.008), intensity-modulated radiotherapy (HR: 0.38, p = 0.03), and lung volume receiving 20 Gy (HR: 54.8, p = 0.03) contributed to the cumulative incidence of RP. Eight patients with grade 5 RP were in the ILA group, seven of whom had ILA-SF. Among radically treated patients, the ILA group had worse 2-year overall survival (OS) than the normal group (35.3% vs 54.6%, p = 0.005). Multivariate analysis revealed that the ILA-SF group contributed to poor OS (HR: 3.07, p =0.02). ILAs, particularly ILA-SF, may be important risk factors for RP, which can worsen prognosis. These findings may aid in making decisions regarding radiotherapy.