Journal
JOURNAL OF RADIATION RESEARCH
Volume 62, Issue 5, Pages 901-909Publisher
OXFORD UNIV PRESS
DOI: 10.1093/jrr/rrab065
Keywords
C-reactive protein (CRP); sarcopenia; stereotactic body radiotherapy (SBRT); lung cancer
Funding
- National Cancer Center Research and Development Fund [23-A-16, 23-A-21, 26-A-4, 29-A3, 2020-J-3, 14S-4, 17S-5, 20S-5, 20S-6]
- Health and Labor Sciences Research Grant for Clinical Cancer Research from the Japanese Ministry of Health, Labor and Welfare [H15-41, H18-014]
- AMED [JP20ck0106581]
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This study suggests that pretreatment CRP level may provide prognostic information in operable patients receiving SBRT for early-stage NSCLC, and that the low SMM group may experience higher incidence of severe toxicities.
This study aimed to evaluate the impact of pretreatment C-reactive protein (CRP) and skeletal muscle mass (SMM) on outcomes after stereotactic body radiotherapy (SBRT) for T1N0M0 non-small cell lung cancer (NSCLC) as a supplementary analysis of JCOG0403. Patients were divided into high and low CRP groups with a threshold value of 0.3 mg/dL. The paraspinous musculature area at the level of the 12th thoracic vertebra was measured on simulation computed tomography (CT). When the area was lower than the sex-specific median, the patient was classified into the low SMM group. Toxicities, overall survival (OS) and cumulative incidence of cause-specific death were compared between the groups. Sixty operable and 92 inoperable patients were included. In the operable cohort, OS significantly differed between the CRP groups (log-rank test p = 0.009; 58.8% and 83.6% at three years for high and low CRP, respectively). This difference in OS was mainly attributed to the difference in lung cancer deaths (Gray's test p = 0.070; 29.4% and 7.1% at three years, respectively). No impact of SMM on OS was observed. The incidence of Grade 3-4 toxicities tended to be higher in the low SMM group (16.7% vs 0%, Fisher's exact test p = 0.052). In the inoperable cohort, no significant impact on OS was observed for either CRP or SMM. The toxicity incidence was also not different between the CRP and SMM groups. The present study suggests that pretreatment CRP level may provide prognostic information in operable patients receiving SBRT for early-stage NSCLC.
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