Pleural contact decreases survival in clinical T1N0M0 lung cancer patients undergoing SBRT

Takahisa Eriguchi, Atsuya Takeda, Yuichiro Tsurugai, Naoko Sanuki, Yuichi Kibe, Yu Hara, Takeshi Kaneko, Masataka Taguri, Naoyuki Shigematsu

Research output: Contribution to journalArticle

Abstract

Background: Clinical staging, as used for patients treated with stereotactic body radiotherapy (SBRT) for early-stage lung cancer, inadequately accounts for pleural invasion, which is a pathologic criteria. Considering the current situation, we analyzed effects of relationships between tumors and the pleura on treatment outcomes of SBRT for early-stage lung cancer. Materials and methods: Among consecutive patients treated with SBRT between 2006 and 2017, we retrospectively identified non-small cell lung cancer patients with primary tumor diameters ≤4 cm and N0M0. The relationships between tumors and the pleura were investigated. The effects of these findings on treatment outcomes were analyzed. Results: We identified 386 patients which met the inclusion criteria. Among these patients, 323 patients were with tumors of 0.1–3.0 cm (T1-size), and 63 patients were with tumors of 3.1–4.0 cm (T2a-size). Among patients with T1-size tumors, 120, 134, and 23 had findings of pleural contact, pleural indentation, and pleural thickening, respectively. When we divided T1-size patients into 2 groups based on pleural contact (contact− or contact+), the 3-year cause-specific mortality and overall survival in patients with T1-size & contact+ were significantly worse than those in patients with T1-size & contact− (17.6% (95% confidence interval (CI), 10.7–25.9%) vs. 6.6% (95% CI, 3.5–11.1%), p < 0.01), and 58.2% (95% CI, 47.6–67.5%) vs. 77.6% (95% CI, 70.5–83.2%), p < 0.01). Local recurrence, regional recurrence, pleural cavity recurrence, and distant metastasis were associated with worse cause-specific mortality and overall survival. On multivariate analysis, pleural contact was associated with cause-specific mortality (hazard ratio (HR), 1.96; 95% CI, 1.09–3.52; p = 0.03) and overall survival (HR, 1.59; 95% CI, 1.08–2.34; p = 0.02). Conclusion: Pleural contact in clinical T1N0M0 lung cancer patients was associated with significantly worse survivals.

Original languageEnglish
Pages (from-to)191-198
Number of pages8
JournalRadiotherapy and Oncology
Volume134
DOIs
Publication statusPublished - 2019 May

Keywords

  • Clinical T stage
  • Pleural contact
  • Pleural invasion
  • SBRT

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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    Eriguchi, T., Takeda, A., Tsurugai, Y., Sanuki, N., Kibe, Y., Hara, Y., Kaneko, T., Taguri, M., & Shigematsu, N. (2019). Pleural contact decreases survival in clinical T1N0M0 lung cancer patients undergoing SBRT. Radiotherapy and Oncology, 134, 191-198. https://doi.org/10.1016/j.radonc.2019.02.005