A recent study, published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC), showed that interstitial lung disease (ILD) is now considered to be a stage I non-small cell lung cancer (NSCLC) iso factor for patients who are being treated with stereotactic body radiation therapy (SBRT) alone.

To assess the ideal treatment for early-stage lung cancer patients suffering with ILD, the incidence of radiation pneumonitis was evaluated by a group of researchers from Kyoto University, Japan.

Interstitial lung disease causes scarring and instability of the tissue and space near the air sacs within the lungs, decreasing gas exchange and the efficiency of the process. ILD incidence has been found to be higher in the cancer patient population than among healthy people. Furthermore, tobacco smoking is a risk factor for both lung cancer patients and the general population; 

For lung cancer patients with ILD that are considered poor candidates for surgical therapy, SBRT can be a good alternative therapy. It uses advanced techniques to stop local tumor growth and can target the affected area with a specific and focused dose of radiation, while minimizing the damage to the surrounding healthy tissue.

In the study, 157 patients were treated with SBRT alone for stage I NSCLC, from which twenty were identified as having pretreatment for ILD. The results showed that ILD was a risk factor for symptomatic and severe radiation pneumonitis;  the cumulative incidence of radiation pneumonitis increased considerably in patients with more severe ILD. Overall survival was smaller in ILD patients, although it was not statistically significant. There were no differences regarding disease progression between both groups of patients.

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“Our results suggest that the impact of ILD on radiation pneumonitis depends on the preexisting severity of the ILD findings and clinicians should be cautious when considering SBRT for those with significant ILD findings. However, other than radiation pneumonitis, life-threatening complications after SBRT are rare. Thus, if the severity of ILD and the risk of radiation pneumonitis are carefully evaluated, SBRT is a curative-intent treatment option for those with early-stage NSCLC and pretreatment ILD,” study authors Yukinori Matsuo and Masahiro Hiraoka, said in an IASLC news release.

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