Longitudinal computed tomography body composition changes in patients receiving curative radiotherapy for non-small cell lung cancer.

Authors

Ying Zhang, Sumeet Hindocha, Arjun K Ghosh, Miguel Garrett Fernandes, Maria A Hawkins, Charles-Antoine Collins Fekete

Published in

Physics and imaging in radiation oncology. Volume 40. Pages 101055. Epub Aug 05, 2026.

Abstract

To determine whether longitudinal changes on routine thoracic computed tomography (CT) predict overall survival (OS) in non-small cell lung cancer (NSCLC) after curative radiotherapy and identify dose predictors of adverse tissue changes.
We performed a retrospective, single-centre study of 231 stage I-IV NSCLC patients who had at least two follow-up scans. In total, 2708 CT scans were analysed (median follow-up, 22 months; range, 1-97). Automated segmentation quantified left ventricular (LV) myocardium, L1 skeletal muscle (SKM) and fat volumes. For each tissue, baseline-normalised trajectories were used to compute monthly rates of change ("velocity"), and non-linear associations with OS were evaluated. Logistic regression identified dose metrics associated with adverse tissue change.
SKM velocity stratified OS (C-index, 0.70): SKM loss < -0.4%/month vs ≥ -0.4%/month, HR 4.41 (95% CI 2.46-7.91, p < 0.005). LV-myocardial mass velocity showed a U-shaped relationship with OS (C-index, 0.75): atrophy < -0.3%/month vs stable, HR 4.12 (95% CI 1.65-10.27, p < 0.005); hypertrophy >0.3%/month vs stable, HR 7.90 (95% CI 2.82-22.15, p < 0.005). Dose predictors included oesophagus V_10Gy for SKM loss (OR, 1.40; p = 0.03), Aorta V_5Gy for myocardial atrophy (OR, 1.71; p = 0.02), and right-atrium V_10Gy for myocardial hypertrophy (OR, 1.63; p = 0.02).
Longitudinal CT biomarkers, particularly SKM loss rate and deviation in LV-myocardial mass, are associated with OS after curative NSCLC irradiation. These findings require validation in multicentre studies with more complete clinical information.

PMID:
42633359
Bibliographic data and abstract were imported from PubMed on 23 Aug 2026.

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