Frakulli Rezarta, Salvi Fabrizio, Balestrini Damiano, Palombarini Marcella, Akshija Ilir, Cammelli Silvia, Morganti Alessio Giuseppe, Zompatori Maurizio, Frezza Giovanni
Radiation Oncology Centre, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Radiation Oncology Unit, Bellaria Hospital, Bologna, Italy.
Transl Lung Cancer Res. 2017 Dec;6(Suppl 1):S1-S7. doi: 10.21037/tlcr.2017.10.01.
Parenchymal changes after stereotactic body radiation therapy (SBRT) make differential diagnosis between treatment outcomes and disease recurrence often difficult. The purpose of our study was to identify the radiographic features detectable at computed tomography (CT) scan [high-risk features (HRFs)] that allow enough specificity and sensitivity for early detection of recurrence.
We retrospectively evaluated patients who underwent SBRT for inoperable early stage non-small cell lung cancer (NSCLC). The median delivered dose performed was 50 Gy in 5 fractions prescribed to 80% isodose. All patients underwent chest CT scan before SBRT and at 3, 6, 12, 18, 24 months after, and then annually. Each CT scan was evaluated and benign and HRFs were recorded. F-fluorodeoxyglucose-CT was not used routinely.
Forty-five patients were included (34 males, 11 females; median age: 77 years; stage IA: 77.8%, stage IB: 22.2%; median follow-up: 21.7 months). Two year and actuarial local control was 77%. HRFs were identified in 20 patients. The most significant predictor of relapse was an enlarging opacity at 12 months (P<0.001) with 84.6% sensitivity and 71.8% specificity. The presence of ≥2 HRFs demonstrated a high sensibility (92.3%) and specificity (71.9%) (P<0.0001).
Detection of HRFs is predictive of relapse with a sensibility that increases with the number of HRFs observed. This observation may allow to better define the diagnostic follow algorithm up suggesting to performing further exams only in patients with >2 HRFs.
立体定向体部放射治疗（SBRT）后实质改变常使治疗结果与疾病复发的鉴别诊断变得困难。我们研究的目的是确定在计算机断层扫描（CT）上可检测到的影像学特征[高危特征（HRF）]，这些特征对复发的早期检测具有足够的特异性和敏感性。
我们回顾性评估了因无法手术的早期非小细胞肺癌（NSCLC）接受SBRT的患者。实施的中位剂量为50 Gy，分5次给予，处方剂量为80%等剂量线。所有患者在SBRT前以及之后3、6、12、18、24个月时接受胸部CT扫描，之后每年进行一次。对每次CT扫描进行评估并记录良性和HRF特征。未常规使用氟脱氧葡萄糖CT。
纳入45例患者（男性34例，女性11例；中位年龄：77岁；IA期：77.8%，IB期：22.2%；中位随访时间：21.7个月）。两年及精算局部控制率为77%。20例患者发现有HRF。复发的最显著预测因素是12个月时出现的增大的不透明影（P<0.001），敏感性为84.6%，特异性为71.8%。≥2个HRF的存在显示出高敏感性（92.3%）和特异性（71.9%）（P<0.0001）。
HRF的检测可预测复发，其敏感性随观察到的HRF数量增加而增加。这一观察结果可能有助于更好地定义诊断随访方案，建议仅对有>2个HRF的患者进行进一步检查。
