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

Abstract

Background: The relationship between interstitial lung abnormalities (ILA) and the outcomes of lung cancer radiotherapy is unclear. This study aimed to investigate whether specific ILA subtypes are risk factors for radiation pneumonitis (RP).
Patients and methods: This retrospective study analysed patients with non-small cell lung cancer treated with radical-intent or salvage radiotherapy. Patients were divided into normal (no abnormalities), ILA, and interstitial lung disease (ILD) groups. The ILA group was further subdivided 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 to compare these outcomes between groups, respectively.
Results: A total of 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 patients (41%). 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 than the normal group (35.3% vs. 54.6%, p=0.005). Multivariate analysis revealed that the ILA-SF group contributed to poor overall survival (HR: 3.07, p=0.02).
Conclusions: ILAs, especially ILA-SF, may be important risk factors for RP, which can worsen prognosis. These findings may aid in making decisions regarding radiotherapy.