Can high-risk CT features suggest local recurrence after stereotactic body radiation therapy for lung cancer? A systematic review and meta-analysis. Issue 127 (June 2020)

• Record Type: Journal Article
• Authors: Kim, Tae-Hyung; Woo, Sungmin; Halpenny, Darragh F.; Kim, Yeon Joo; Yoon, Soon Ho; Suh, Chong Hyun
• Is Part Of: European journal of radiology. Issue 127(2020)
• Publication Date: 2020-06
• Subjects: CI Confidence intervals -- CT Computed tomography -- HRFs High-risk CT features -- NSCLC Non-small cell lung cancer -- OR Odds ratio -- PET Positron emission tomography -- PICOS Patient, index test, comparator, outcome, and study design -- PRISMA Preferred reporting items for systematic reviews and meta-analyses guidelines -- QUADAS-2 Quality Assessment of Diagnostic Accuracy Studies-2 -- SBRT Stereotactic body radiation therapy -- SCLC Small cell lung cancer; Stereotactic radiation therapy -- Computed tomography -- X-Ray -- Lung cancer -- Meta-analysis -- Systematic review; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.108978
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: It is hard to differentiate complex lung changes after SBRT from local recurrence. Several HRFs on follow-up CT after SBRT were useful in favoring local recurrence. These HRFs may help raise clinical suspicion of local recurrence on follow-up CT. Abstract: Purpose: To perform a systematic review and meta-analysis evaluating usefulness of high-risk CT features (HRFs) on follow-up CT in detecting local recurrence after stereotactic body radiation therapy (SBRT) in lung cancer patients. Methods: Pubmed and EMBASE were searched up to January 11th, 2019. We included studies that differentiated local recurrence from post-SBRT changes after SBRT on follow-up CT in lung cancer patients. Methodological quality was assessed using QUADAS-2. The association between HRFs and local recurrence were pooled in the form of odds ratio (OR) using the random effects model. Heterogeneity was examined by the Inconsistency index (I 2 ). Results: Eight studies were included, consisting of 356 lung cancer patients. The overall prevalence of patients with local recurrence was 18.8 % (67/356). Compared with post-SBRT changes, local recurrence after SBRT more frequently demonstrated air-bronchogram disappearance (OR = 7.15), bulging margin (OR = 24.12), craniocaudal growth (OR = 26.07), enlargement after 12 months (OR = 28.11), enlarging opacity (OR = 7.92), linear margin disappearance (OR = 29.24), and sequential enlargement (OR = 83.23) (p ≤ 0.02). Pleural effusion appearance was not related with local recurrence (p = 0.82). Heterogeneity varied among HRFs (I 2 = 0–91 %). The quality of the studies was considered moderate. Conclusions: Several HRFs on follow-up CT after SBRT were useful in suggesting local recurrence. These HRFs may help raise clinical suspicion of local recurrence, initiate prompt additional test for confirmation and perform subsequent proper personalized salvage treatment.