Toxicity and Patterns of Failure of Adaptive/Ablative Proton Therapy for Early-Stage, Medically Inoperable Non-Small Cell Lung Cancer

Journal Article · Mon Aug 01 04:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.04.049· OSTI ID:21587644

Komaki, Ritsuko; Wen, Hong Y; De Gracia, Beth; Bluett, Jaques B; McAleer, Mary F ^[1]; Swisher, Stephen G ^[2]; Gillin, Michael; Mohan, Radhe ^[3]; Cox, James D ^[1]

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1. Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
2. Department of Thoracic/Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
3. Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

Purpose: To analyze the toxicity and patterns of failure of proton therapy given in ablative doses for medically inoperable early-stage non-small cell lung cancer (NSCLC). Methods and Materials: Eighteen patients with medically inoperable T1N0M0 (central location) or T2-3N0M0 (any location) NSCLC were treated with proton therapy at 87.5 Gy (relative biological effectiveness) at 2.5 Gy /fraction in this Phase I/II study. All patients underwent treatment simulation with four-dimensional CT; internal gross tumor volumes were delineated on maximal intensity projection images and modified by visual verification of the target volume in 10 breathing phases. The internal gross tumor volumes with maximal intensity projection density was used to design compensators and apertures to account for tumor motion. Therapy consisted of passively scattered protons. All patients underwent repeat four-dimensional CT simulations during treatment to assess the need for adaptive replanning. Results: At a median follow-up time of 16.3 months (range, 4.8-36.3 months), no patient had experienced Grade 4 or 5 toxicity. The most common adverse effect was dermatitis (Grade 2, 67%; Grade 3, 17%), followed by Grade 2 fatigue (44%), Grade 2 pneumonitis (11%), Grade 2 esophagitis (6%), and Grade 2 chest wall pain (6%). Rates of local control were 88.9%, regional lymph node failure 11.1%, and distant metastasis 27.8%. Twelve patients (67%) were still alive at the last follow-up; five had died of metastatic disease and one of preexisting cardiac disease. Conclusions: Proton therapy to ablative doses is well tolerated and produces promising local control rates for medically inoperable early-stage NSCLC.

• OSTI ID: 21587644
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 80; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BARYONS
BODY
CHEST
DERMATITIS
DISEASES
DOSES
ELEMENTARY PARTICLES
FATIGUE
FERMIONS
HADRONS
LUNGS
LYMPH NODES
LYMPHATIC SYSTEM
MECHANICAL PROPERTIES
MEDICINE
METASTASES
NEOPLASMS
NUCLEAR MEDICINE
NUCLEONS
ORGANS
PNEUMONITIS
PROTONS
RADIATION DOSES
RADIOLOGY
RADIOTHERAPY
RESPIRATION
RESPIRATORY SYSTEM
SKIN DISEASES
THERAPY
TOXICITY