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Original Research: Lung Cancer |

Reassessment of Declines in Pulmonary Function ≥ 1 Year After Stereotactic Body RadiotherapyPulmonary Function After Stereotactic Radiotherapy

Atsuya Takeda, MD, PhD; Tatsuji Enomoto, MD, PhD; Naoko Sanuki, MD; Hiroshi Handa, MD; Yousuke Aoki, RTT; Yohei Oku, PhD; Etsuo Kunieda, MD, PhD
Author and Funding Information

From the Department of Radiology (Drs Takeda and Sanuki, Mr Aoki, and Dr Oku), Ofuna Chuo Hospital, Kanagawa; Department of Radiology (Dr Takeda), and Department of Respirology (Dr Enomoto), Tokyo Metropolitan Hiroo General Hospital, Tokyo; Department of Respirology (Dr Handa), Ofuna Chuo Hospital, Kanagawa; and Department of Radiation Oncology (Dr Kunieda), Tokai University, Kanagawa, Japan.

Correspondence to: Etsuo Kunieda, MD, PhD, Department of Radiation Oncology, Tokai University, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan; e-mail: kunieda-mi@umin.ac.jp


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):130-137. doi:10.1378/chest.12-0207
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Background:  Stereotactic body radiation therapy (SBRT) is standard care for patients with inoperable early-stage non-small cell lung cancer. However, clinicians may hesitate to use SBRT in patients with severe COPD because of potential negative effects on pulmonary function. We quantitatively analyzed long-term declines in pulmonary function after SBRT to ascertain lifelong tolerability to SBRT.

Methods:  Between 2005 and 2010 at Ofuna Chuo Hospital, 292 patients with lung tumors were treated with SBRT. Among them, patients who underwent pulmonary function tests (PFTs) both pretreatment and at ≥ 1 year after SBRT were evaluated in this retrospective analysis. The decline ratio in FEV1 and FVC was assessed (ie, ΔFEV1/preFEV1 and ΔFVC/preFVC). Predictors were identified using univariate and multivariate analyses.

Results:  The 141 eligible patients had follow-up PFTs at a median of 21.0 (range, 12.0-74.8) months after SBRT. Among groups with normal function, or mild to moderate or severe COPD, the median values for ΔFEV1/preFEV1 were 7.9%, 7.9%, and 7.4%, respectively, and for ΔFVC/preFVC, 5.1%, 3.4%, and 0.5%, respectively. Low BMI was the only predictor for ΔFEV1/preFEV1 > 10%. Low BMI, high lung volume receiving ≥ 20 Gy, and high pretreatment FVC were predictors for ΔFVC/preFVC > 10%.

Conclusions:  Declines in FEV1 and FVC were small, but statistically significant in patients with normal function or mild to moderate COPD, but nonsignificant in patients with severe COPD. These declines were primarily due to physiologic aging. SBRT had a limited effect on decline in long-term pulmonary function and may be an acceptable alternative to surgery for patients with comorbid lung cancer and COPD.

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