Evaluation of Pulmonary Functions by Spirometry after Stereotactic Body Radiotherapy in Lung Tumors

Main Article Content

Alexandra Giraldo Marin http://orcid.org/0000-0002-7484-9715 Abraham André Arturo Geng Cahuayme http://orcid.org/0000-0002-5185-5653 Mónica Ramos Albiac Enar Recalde Vizcay http://orcid.org/0000-0001-5269-2246 Josep Garre Cristau Xavier Maldonado Pijoan http://orcid.org/0000-0003-2045-4723 Jordi Giralt López de Sagredo http://orcid.org/0000-0002-1840-5159

Abstract

Introduction: To evaluate changes in pulmonary function by spirometry after stereotactic body radiotherapy (SBRT). 


Methods: A single-center, retrospective study was performed which analyzed lung function after SBRT from January 1, 2015 to January 31, 2020. Eligible patients were ≥18 years of age, with early-stage lung cancer or lung metastases ≤5 cm and Karnofsky performance status (KPS) >70. Patients were excluded if they had a history of non-infectious pneumonitis or interstitial lung disease. Clinical cases were discussed in a multidisciplinary tumor board, and the patients were classified as surgically resectable but medically inoperable. Mixed-effects models were used to evaluate changes in forced expiratory volume in 1 (FEV1), forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO) at 3, 6, 12, and 24 months after SBRT.


Results: Fifty-two patients underwent SBRT. Median follow-up spirometry post-SBRT was 12 months (range, 12-24).  No significant differences were observed during the first year in both liters and the percentage of predicted FEV1 evolution. A gain of 5.9% [95% CI, 2.3; 9.6 percent (p=0.0014)] was beheld after 24 months post-SBRT. Although, no significant difference has been viewed when we analyze it in liters with an FEV1 value 24 months post-SBRT of 1.57 liters [95% CI, 1.56; 1.59 liters (p=0.848)]. There are no differences when we analyze FVC evolution according to liters during the first two years post treatment. Finally, no differences were observed when analyzing DLCO evolution according to percentage or as ml/min/kPa.


Conclusions: SBRT in primary lung tumors or pulmonary metastases does not negatively influence pulmonary function assessed by spirometry at least in the first two years after treatment.

Keywords: Lung Neoplasms, Neoplasm Metastasis, Stereotactic Radiation Therapy, Spirometry

Article Details

How to Cite
MARIN, Alexandra Giraldo et al. Evaluation of Pulmonary Functions by Spirometry after Stereotactic Body Radiotherapy in Lung Tumors. Medical Research Archives, [S.l.], v. 11, n. 6, june 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3754>. Date accessed: 07 dec. 2024. doi: https://doi.org/10.18103/mra.v11i6.3754.
Section
Research Articles

References

1. American Cancer Society. Cancer Facts & Figures 2021. Accessed October 15, 2022. https://cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2021.html.
2. Groome PA, Bolejack V, Crowley JJ, et al. The IASLC Lung Cancer Staging Project: validation of the proposals for revision of the T, N, and M descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2(8):694-705.
3. Rami-Porta R, Wittekind C, Goldstraw P. Complete resection in lung cancer surgery: proposed definition. Lung Cancer. 2005;49(1):25-33.
4. Onishi H, Shioyama Y, Matsumoto Y, et al. Stereotactic body radiotherapy in patients with lung tumors composed of mainly ground-glass opacity. J Radiat Res. 2020;61(3):426-30.
5. Matsuo Y, Chen F, Hamaji M, et al. Comparison of long-term survival outcomes between stereotactic body radiotherapy and sublobar resection for stage I non-small-cell lung cancer in patients at high risk for lobectomy: A propensity score matching analysis. Eur J Cancer. 2014;50(17):2932-8.
6. Chang JY, Senan S, Paul MA, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16(6):630-7.
7. Nagata Y, Hiraoka M, Shibata T, et al. Prospective Trial of Stereotactic Body Radiation Therapy for Both Operable and Inoperable T1N0M0 Non-Small Cell Lung Cancer: Japan Clinical Oncology Group Study JCOG0403. Int J Radiat Oncol Biol Phys. 2015;93(5):989-96.
8. Shibamoto Y, Hashizume C, Baba F, et al. Stereotactic body radiotherapy using a radiobiology-based regimen for stage I non-small-cell lung cancer: five-year mature results. J Thorac Oncol. 2015;10(6):960-4.
9. Miyakawa A, Shibamoto Y, Baba F, et al. Stereotactic body radiotherapy for stage I non-small-cell lung cancer using higher doses for larger tumors: results of the second study. Radiat Oncol. 2017;12(1):152.
10. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8-10.
11. Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet. 2019;393(10185):2051-8.
12. Cao C, Louie BE, Melfi F, et al. Impact of pulmonary function on pulmonary complications after robotic-assisted thoracoscopic lobectomy. Eur J Cardiothorac Surg. 2020;57(2):338-42.
13. Burt BM, Kosinski AS, Shrager JB, Onaitis MW, Weigel T. Thoracoscopic lobectomy is associated with acceptable morbidity and mortality in patients with predicted postoperative forced expiratory volume in 1 second or diffusing capacity for carbon monoxide less than 40% of normal. J Thorac Cardiovasc Surg. 2014;148(1):19-28, dicussion 28-29.e1.
14. Kearney DJ, Lee TH, Reilly JJ, DeCamp MM, Sugarbaker DJ. Assessment of operative risk in patients undergoing lung resection. Importance of predicted pulmonary function. Chest. 1994;105(3):753-9.
15. Ferguson MK, Little L, Rizzo L, et al. Diffusing capacity predicts morbidity and mortality after pulmonary resection. J Thorac Cardiovasc Surg. 1988;96(6):894-900.
16. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33.
17. Ambrogi V, Pompeo E, Elia S, Pistolese GR, Mineo TC. The impact of cardiovascular comorbidity on the outcome of surgery for stage I and II non-small-cell lung cancer. Eur J Cardiothorac Surg. 2003;23(5):811-7.
18. Kravchenko J, Berry M, Arbeev K, Lyerly HK, Yashin A, Akushevich I. Cardiovascular comorbidities and survival of lung cancer patients: Medicare data based analysis. Lung Cancer. 2015;88(1):85-93.
19. Timmerman R, Papiez L, McGarry R, et al. Extracranial stereotactic radioablation: results of a phase I study in medically inoperable stage I non-small cell lung cancer. Chest. 2003;124(5):1946-55.
20. Henderson M, McGarry R, Yiannoutsos C, et al. Baseline pulmonary function as a predictor for survival and decline in pulmonary function over time in patients undergoing stereotactic body radiotherapy for the treatment of stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2008;72(2):404-9.
21. Ohashi T, Takeda A, Shigematsu N, et al. Differences in pulmonary function before vs. 1 year after hypofractionated stereotactic radiotherapy for small peripheral lung tumors. Int J Radiat Oncol Biol Phys. 2005;62(4):1003-8.
22. Stanic S, Paulus R, Timmerman RD, et al. No clinically significant changes in pulmonary function following stereotactic body radiation therapy for early- stage peripheral non-small cell lung cancer: an analysis of RTOG 0236. Int J Radiat Oncol Biol Phys. 2014;88(5):1092-9.
23. Takeda A, Kunieda E, Ohashi T, et al. Severe COPD is correlated with mild radiation pneumonitis following stereotactic body radiotherapy. Chest. 2012;141(4):858-66.
24. Takemoto S, Shibamoto Y, Hashizume C, et al. Changes in pulmonary function and their correlation with dose-volume parameters in patients undergoing stereotactic body radiotherapy for lung cancer. J Radiat Res. 2021;62(2):338-45.
25. Stephans KL, Djemil T, Reddy CA, et al. Comprehensive analysis of pulmonary function Test (PFT) changes after stereotactic body radiotherapy (SBRT) for stage I lung cancer in medically inoperable patients. J Thorac Oncol. 2009;4(7):838-44.
26. Stone B, Mangona VS, Johnson MD, Ye H, Grills IS. Changes in Pulmonary Function Following Image-Guided Stereotactic Lung Radiotherapy: Neither Lower Baseline Nor Post-SBRT Pulmonary Function Are Associated with Worse Overall Survival. J Thorac Oncol. 2015;10(12):1762-9.
27. Timmerman R, Paulus R, Galvin J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010;303(11):1070-6.
28. Liu Y, Wang W, Shiue K, et al. Risk factors for symptomatic radiation pneumonitis after stereotactic body radiation therapy (SBRT) in patients with non-small cell lung cancer. Radiother Oncol. 2021;156:231-8.
29. Saha A, Beasley M, Hatton N, et al. Clinical and dosimetric predictors of radiation pneumonitis in early-stage lung cancer treated with Stereotactic Ablative radiotherapy (SABR) - An analysis of UK's largest cohort of lung SABR patients. Radiother Oncol. 2021;156:153-9.
30. Kong FS, Moiseenko V, Zhao J, et al. Organs at Risk Considerations for Thoracic Stereotactic Body Radiation Therapy: What Is Safe for Lung Parenchyma. Int J Radiat Oncol Biol Phys. 2021;110(1):172-87.
31. Guckenberger M, Kestin LL, Hope AJ, et al. Is there a lower limit of pretreatment pulmonary function for safe and effective stereotactic body radiotherapy for early-stage non-small cell lung cancer. J Thorac Oncol. 2012;7(3):542-51.