Pretreatment pulmonary interstitial change (PIC) has been indicated as a risk factor of severe radiation pneumonitis (RP) following stereotactic body radiation therapy (SBRT) for early-stage lung cancer, but details of its true effect remain unclear. This study aims to evaluate treatment outcomes of SBRT for stage I non-small cell lung cancer in patients with PIC. A total of 242 patients are included in this study (88% male). The median age is 77 years (range, 55–92 years). A total dose of 40–70 Gy is administered in 4 to 10 fractions during a 4-to-25 day period. One, two, and three-year overall survival (OS) rates are 82.1%, 57.1%, and 42.6%, respectively. Fatal RP is identified in 6.9% of all patients. The percent vital capacity 10%), performance status of 2–4, presence of squamous cell carcinoma, clinical T2 stage, regular use of steroid before SBRT, and percentage predicting forced expiratory volume in one second (<70%) are associated with worse prognoses for OS. Our results indicate that fatal RP frequently occurs after SBRT for stage I lung cancer in patients with PIC.

Surgery is the standard treatment for stage I non-small cell lung cancer (NSCLC); however, no clear randomized trial demonstrates its superiority to stereotactic body radiotherapy (SBRT) regarding survival. We aimed to retrospectively evaluate the treatment outcomes of SBRT in operable patients with stage I NSCLC using a large Japanese multi-institutional database to show real-world outcome. Exactly 399 patients (median age 75 years; 262 males and 137 females) with stage I (IA 292, IB 107) histologically proven NSCLC (adenocarcinoma 267, squamous cell carcinoma 96, others 36) treated at 20 institutions were reviewed. SBRT was prescribed at a total dose of 48–70 Gy in 4–10 fractions. The median follow-up period was 38 months. Local progression-free survival rates were 84.2% in all patients and 86.1% in the T1, 78.6% in T2, 89.2% in adenocarcinoma, and 70.5% in squamous cell subgroups. Overall 3-year survival rates were 77.0% in all patients: 90.7% in females, 69.6% in males, and 41.2% in patients with pulmonary interstitial changes. Fatal radiation pneumonitis was observed in two patients, all of whom had pulmonary interstitial changes. This real-world evidence will be useful in shared decision-making for optimal treatment, including SBRT for operable stage I NSCLC, particularly in older patients.

Gastric-type adenocarcinoma (GAS) of the cervix is usually diagnosed at advanced stages and has a poor prognosis due to resistance to standard therapies. Although immune checkpoint inhibitors have improved outcomes in cervical cancer, prognosis and treatment response are strongly influenced by the tumor immune microenvironment (TME). Histopathological assessment of GAS is challenging because it often arises in the upper cervix. This study aimed to predict the TME in GAS using MRI-based radiomics. We enrolled 16 patients with GAS treated at our institution. Tumor-infiltrating lymphocytes (TILs) were evaluated by immunohistochemistry, quantifying them with the Immunoscore. Fourteen patients with usual endocervical adenocarcinoma (UEA) served as controls. A total of 1,309 radiomic features were extracted from the primary tumor and peritumoral region on pre-treatment MRI images. After feature selection, clustering, and regression models were developed to predict the TME in GAS. GAS exhibited significantly lower T-cell infiltration than UEA, particularly in early-stage tumors. The clustering model achieved 87.5% accuracy in Immunoscore classification, and the regression model showed a strong correlation with observed TIL densities (r = 0.93, P < .001). These findings suggest that MRI-based radiomics may serve as a noninvasive biomarker for predicting the TME in GAS.