Assessing actionable radiological features on serial CT images in Post-SABR patients with resected local recurrence of colorectal lung metastases.

Authors

Simone A Gooijer, Famke L Schneiders, Chris Dickhoff, Jurriaan B Tuynman, David J Heineman, Suresh Senan, Martijn van Dorp

Published in

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. Volume 52. Issue 10. Pages 111998. Jul 09, 2026. Epub Jul 09, 2026.

Abstract

Diagnosing local recurrence (LR) of colorectal lung metastases (CLM) after stereotactic ablative radiotherapy (SABR) is complex; both by distinguishing benign radiological changes from LR on imaging and challenges in obtaining pathological confirmation. Actionable radiological features (aRFs) have been proposed for an earlier diagnosis of post-SABR recurrences in the lung.
We retrospectively studied patients who had undergone salvage surgery after primary SABR for a CLM between 2014 and 2023 and with pathologically proven LR. Two thoracic radiation oncologists separately assessed all available pre-SABR and follow-up chest CT-scans to identify aRFs. Presence of the following aRFs were scored: Sequential enlarging opacity; bulging margin; craniocaudal growth; loss of linear margin; loss of air bronchogram. LR was suspected if ≥ 2 aRFs were present.
Seventeen lesions met study eligibility criteria. Median time to salvage resection was 26 months post-SABR (IQR:19-31). Local recurrence was suspected using aRFs in 15 lesions (88%). Suspected LRs were identified at a median of 11 months before salvage surgery (IQR:4-16). The commonest aRFs scored before salvage resection were bulging margin (94%), sequential enlarging opacity (82%), and craniocaudal growth (76%).
In patients with recurrent CLM post-SABR, 88% had aRFs indicating LR on pre-surgery CT-thorax. Local recurrence was identified 11 months earlier based on the presence of ≥2 aRFs. These findings demonstrate that aRFs are present in most patients with LR and using aRFs may allow for an earlier and imaging-based diagnosis.

PMID:
42542013
Bibliographic data and abstract were imported from PubMed on 02 Aug 2026.

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