Stereotactic body radiation therapy for clinically diagnosed early-stage non-small cell lung cancer: Importance of accurate CT interpretation by experts

IntroductionThis study evaluated the clinical outcomes of stereotactic body radiotherapy (SBRT) for both pathologically diagnosed (PD) and clinically diagnosed (CD) early-stage non-small cell lung cancer (NSCLC) and explored the significance of accurate expert computed tomography (CT) interpretation.MethodsWe retrospectively analyzed 95 patients with early-stage NSCLC who received SBRT at our institution. Patients were classified into CD and PD groups. Two chest radiologists retrospectively interpreted the pre-SBRT CT images to determine the tumor subtype and probability of malignancy (PM). Clinical findings, CT features, and treatment outcomes were compared between the two groups. The survival rate of the CD group was analyzed separately according to the PM grade.ResultsMedian overall survival for the CD and PD groups was 6.0 and 5.4 years (P = 0.57), respectively. Median cause-specific survival was 10.2 years in the CD group and not reached in the PD group (P = 0.76). In the CD group, lung cancer mortality was lower in the low PM group (25% [1 of 4]) than in the high PM group (47.4% [9 of 19]).ConclusionIt may be desirable to evaluate the PM of the nodule using expert CT interpretation to decide whether SBRT is indicated in CD early-stage NSCLC. The present study investigated the clinical outcomes of stereotactic body radiotherapy (SBRT) for pathologically diagnosed (PD) and clinically diagnosed (CD) early-stage non-small cell lung cancer and examined the importance of accurate CT interpretations by experts. Overall survival and cause-specific survival curves showed no significant difference between the PD and CD groups. (a, b). The CD group was divided into the low probability of malignant (PM) group and the high PM group by CT interpretation. Although there was no significant difference in the OS and CSS curves of the high and low PM groups (c), lung cancer mortality was lower in the low PM group (25% [1 of 4]) that in the high PM group (47.4% [9 of 19]). image