The impact of chemotherapy on persistent ground-glass nodules in patients with lung adenocarcinoma

Abstract

Backgrounds: To evaluate the response of persistent ground glass nodules (GGNs) in patients with lung adenocarcinoma treated with platinum-based chemotherapy on computed tomography (CT).

Methods: We retrospectively studied patients with GGNs that met the following criteria: (I) GGNs found in patients with lung adenocarcinoma, which persist for more than 3 months; (II) patients treated with platinum-based (cisplatin or carboplatin) chemotherapy for at least 2 cycles; (III) ground glass proportion ¡Ý50%. For each patient, if more than two CTs satisfied the inclusion criteria, then the baseline and last CTs were used for analysis, defined as CT1 and CT2. A total of 91 persistent pulmonary GGNs in 51 patients fulfilled the inclusion criteria. We defined growth as a nodule ¡Ý2 mm increase in diameter or showing up a solid portion. GGN response to therapy was assessed and compared with the baseline CT. Differences in CT findings were analyzed using a paired t-test and Pearson ¦Ö² test.

Results: Between 2010 and 2015, 25 of the 51 (49%) were male and 26 of the 51 (51%) were female. The average age at time of detection of a GGN was 63.8 (range, 36-84) years. Mean follow-up duration was 24.1¡À17.9 months. During the follow-up periods, on a per-nodule basis, 94.5% of GGNs (n=86) remained unchanged in size. Only 5.5% GGNs (n=5) in 5 patients increased in size. The nodules CT feature in each lung adenocarcinoma clinical stage show no difference. No significant difference was found in the size, attenuation, volume, and mass of GGN between baseline and post-treatment measurements, regardless of the type of chemotherapy (P>0.05).

Conclusions: The clinical course of GGNs in patients with lung adenocarcinoma is predominantly indolent, and platinum-based chemotherapy may have no effect on the growth of persistent GGNs.

Keywords: Ground-glass nodules (GGNs); adenocarcinoma; chemotherapy; lung cancer.

Figure 1

A 74-year-old woman with adenocarcinoma. (A, B) Pre-operation CT scans show a mass and multiple variable-sized nodule in left upper lobe; (C) baseline thin-section CT scan shows a 11-mm well defined pure ground glass nodule (arrow) in right upper lobe; (D) follow-up thin-section CT scan after 5 cycles cisplatin-based chemotherapy obtains 1 year shows unchangeableness of this pure ground glass nodule seen in (C). CT, computed tomography.

Figure 2

A 47-year-old woman with adenocarcinoma. (A,B) Pre-operation CT scans show a mass in right lower lobe; (C) baseline thin-section CT scan shows a 7-mm well defined pure ground glass nodule (arrow) in left lower lobe; (D) follow-up thin-section CT scan after 7 cycles carboplatin-based chemotherapy obtains 1.5 years shows increasing in size of this pure ground glass nodule seen in (C). CT, computed tomography.