High-risk CT features for detection of local recurrence after stereotactic ablative radiotherapy for lung cancer
High-risk CT features for detection of local recurrence after stereotactic ablative radiotherapy for lung cancer
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DOI：
10.1016/j.radonc.2013.06.047
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发表时间：
2013-10-01
影响因子：
5.7
通讯作者：
Senan, Suresh
中科院分区：
文献类型：
--
作者：
Huang, Kitty;Senthi, Sashendra;Senan, Suresh
背景和目的：肺癌立体定向消融放疗（SABR）后局部复发的早期检测可能允许治愈性挽救治疗，但复发可能难以与纤维化区分。我们研究了CT成像高风险特征（HRFs）检测局部复发的临床表现。材料和方法：2003年至2012年期间接受SABR治疗的早期肺癌患者，病理证实局部复发（n = 12），根据基线因素，将其与无复发患者（n = 24）1：2匹配。系列CT图像由盲法放射肿瘤学家进行评估。以往报道的HRF包括：（1）原发灶阴影增大;（2）连续阴影增大;（3）12个月后阴影增大;（4）边缘隆起;（5）线性边缘消失;（6）支气管充气消失（p < 0.01），并且鉴定了一种新的HRF：颅-尾生长（p < 0.001）。局部复发的最佳个体预测因子是12个月后的混浊扩大（100%敏感性，83%特异性，p < 0.001）。每检测到一个额外的HRF，复发的几率增加4倍。≥ 3个HRFs的存在对复发具有高度敏感性和特异性（均>90%）。结论：系统评估SABR术后CT图像的HRFs能够准确预测局部复发。(C)2013爱思唯尔爱尔兰有限公司保留所有权利。
Background and purpose: Early detection of local recurrences following stereotactic ablative radiotherapy (SABR) for lung cancer may allow for curative salvage treatment, but recurrence can be difficult to distinguish from fibrosis. We studied the clinical performance of CT imaging high-risk features (HRFs) for detecting local recurrence.Materials and methods: Patients treated with SABR for early stage lung cancer between 2003 and 2012 who developed pathology-proven local recurrence (n = 12) were matched 1:2 to patients without recurrences (n = 24), based on baseline factors. Serial CT images were assessed by blinded radiation oncologists. Previously reported HRFs were (1) enlarging opacity at primary site; (2) sequential enlarging opacity; (3) enlarging opacity after 12-months; (4) bulging margin; (5) loss of linear margin and (6) air bronchogram loss.Results: All HRFs were significantly associated with local recurrence (p < 0.01), and one new HRF was identified: cranio-caudal growth (p < 0.001). The best individual predictor of local recurrence was opacity enlargement after 12-months (100% sensitivity, 83% specificity, p < 0.001). The odds of recurrence increased 4-fold for each additional HRF detected. The presence of >= 3 HRFs was highly sensitive and specific for recurrence (both >90%).Conclusion: The systematic assessment of post-SABR CT images for HRFs enables the accurate prediction of local recurrence. (C) 2013 Elsevier Ireland Ltd. All rights reserved.