Computer Assisted Nodule Analysis and Risk Yield Outcomes May be Associated with Recurrence after Stereotactic Body Radiation Therapy in Clinical Stage I Non–Small-Cell Lung Cancer

Abstract

Objective There is a paucity of pretreatment, noninvasive assessment of tumor characteristics in non–small-cell lung cancer (NSCLC) undergoing stereotactic body radiation therapy (SBRT). Our goal was to determine if Computer Assisted Nodule Analysis and Risk Yield (CANARY) could stratify risk for recurrence in patients undergoing SBRT for clinical stage I NSCLC. Methods We performed a retrospective review of NSCLC patients who underwent SBRT from 2016 to 2022. Recurrence dates were collected from the date of therapy to May 2023. Pretreatment imaging was entered into the CANARY software, the correct lesion verified and demarcated, and each lesion was categorized into good, intermediate, and poor Score Indicative of Lung Cancer Aggression (SILA). Kaplan–Meier methodology was used to analyze the recurrence free survival (RFS), and Log-rank test was used for group comparison. Results The SBRT cohort included 85 patients. By clinical stage, there were 4 (4.7%) IA1, 41 (48.2%) IA2, 30 (35.3%) IA3, and 10 (11.8%) IB. By histology, 48 (56.5%) patients were adenocarcinoma, 23 (27.1%) were squamous cell carcinoma, and 14 (16.5%) were NSCLC. The 2-year RFS was 68.5%. By CANARY, 11 (12.9%) patients were considered to have good risk, 14 (17.6%) intermediate risk, and 60 (70.6%) poor risk by their SILA scores. Their 2-year RFS was 100.0% (100.0%-100.0%), 80.2% (58.7%-100.0%), and 68.1% (54.4%-85.3%), respectively. Intermediate and poor SILA scores had worse RFS than good SILA score patients ( P = .09). Conclusions CANARY can potentially risk stratify recurrence in clinical stage I NSCLC patients undergoing SBRT.