Alberts, L. (Leonie) (2015) Changes in pulmonary function after stereotactic body radiotherapy and after surgery for stage I and II non-small-cell lung cancer. thesis, Medicine.
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Abstract
Background Although surgical resection is the standard treatment for stage I and II non-small-cell lung cancer (NSCLC), approximately 20% of these patients are not eligible for surgery. Stereotactic body radiotherapy (SBRT) is a good alternative treatment for these patients. Lung resection will lead to a decrease in pulmonary function. However, previous studies have shown that pulmonary function after SBRT remains either stable or shows a small decline post-SBRT. In this study changes in pulmonary function tests (PFTs) were evaluated at different follow-up durations, up to more than two years after treatment in both groups. Methods All patients diagnosed with stage I and II NSCLC and treated with SBRT or surgery between 2008 and 2011 at St. Antonius Hospital Nieuwegein, The Netherlands were included. There was no routine protocol for assessment of post-treatment PFTs. Therefore, follow-up durations were categorized in three categories: early (0-9 months), middle (10-21 months) and late (≥ 22 months). In this study the absolute and percentage of predicted values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), diffusion capacity to carbon monoxide corrected for the actual hemoglobin level (DLCOc) and carbon monoxide transfer coefficient (KCOc) were assessed. Changes in PFT-values were expressed as relative to the pre-treatment value. Wilcoxon signed-rank test for paired samples was used to analyze statistical differences between baseline- and follow-up PFTs. Results Among 228 patients, 123 patients had both pre- and a minimum of one post-treatment PFT. Of the 123 patients, 30 patients were treated with SBRT and 93 patients with surgery. Median pre-treatment FEV1 and DLCOc values were respectively 1.22 liter (54.61% of predicted) and 4.31 mL/min/mmHg (57.00% of predicted) in the SBRT group and 2.33 liter (86.90% of predicted) and 6.05 mL/min/mmHg (70.90% of predicted) in the surgery group. FEV1, FVC and DLCOc have significantly diminished after surgery for all follow-up durations, KCOc remained stable. Relative changes were respectively: 17%; 11%; 15% and 3% of predicted values. After SBRT, absolute FEV1 and FVC values remained stable up to 22 months. After 22 months a statistical significant change was observed in FEV1 and FVC of around 11%. This difference was not observed for percentage of predicted values. DLCOc and KCOc were not significantly impaired after SBRT. Conclusion Surgery for stage I and II non-small-cell lung cancer resulted in a decline of pulmonary function, shortly after resection and no improvement was observed. While pulmonary function after SBRT remained stable on short-term and showed a declining trend at long-term follow-up. However, this trend might rather be due to physiological processes than to treatment-related toxicity.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Heemst, Drs. R.C. van |
| Supervisor name: | Kastelijn, Dr. E.A. and Schramel, Dr. F.M.N.H. and Department of Pulmonology and St. Antonius Hospital, Nieuwegein |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:07 |
| Last Modified: | 25 Jun 2020 11:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2715 |
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