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Title: Phase 1 Study of Dose Escalation in Hypofractionated Proton Beam Therapy for Non-Small Cell Lung Cancer

Abstract

Background: Many patients with locally advanced non-small cell lung cancer (NSCLC) cannot undergo concurrent chemotherapy because of comorbidities or poor performance status. Hypofractionated radiation regimens, if tolerable, may provide an option to these patients for effective local control. Methods and Materials: Twenty-five patients were enrolled in a phase 1 dose-escalation trial of proton beam therapy (PBT) from September 2010 through July 2012. Eligible patients had histologically documented lung cancer, thymic tumors, carcinoid tumors, or metastatic thyroid tumors. Concurrent chemotherapy was not allowed, but concurrent treatment with biologic agents was. The dose-escalation schema comprised 15 fractions of 3 Gy(relative biological effectiveness [RBE])/fraction, 3.5 Gy(RBE)/fraction, or 4 Gy(RBE)/fraction. Dose constraints were derived from biologically equivalent doses of standard fractionated treatment. Results: The median follow-up time for patients alive at the time of analysis was 13 months (range, 8-28 months). Fifteen patients received treatment to hilar or mediastinal lymph nodes. Two patients experienced dose-limiting toxicity possibly related to treatment; 1 received 3.5-Gy(RBE) fractions and experienced an in-field tracheoesophageal fistula 9 months after PBT and 1 month after bevacizumab. The other patient received 4-Gy(RBE) fractions and was hospitalized for bacterial pneumonia/radiation pneumonitis 4 months after PBT. Conclusion: Hypofractionated PBT to the thorax delivered overmore » 3 weeks was well tolerated even with significant doses to the lungs and mediastinal structures. Phase 2/3 trials are needed to compare the efficacy of this technique with standard treatment for locally advanced NSCLC.« less

Authors:
 [1];  [2];  [3]; ; ; ; ; ;  [2]
  1. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
Publication Date:
OSTI Identifier:
22224525
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 86; Journal Issue: 4; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; CHEST; DOSE EQUIVALENTS; LIMITING VALUES; LUNGS; LYMPH NODES; METASTASES; NEOPLASMS; PATIENTS; PNEUMONIA; PNEUMONITIS; PROTON BEAMS; RADIATION DOSES; RBE; THYROID; TOXICITY

Citation Formats

Gomez, Daniel R., E-mail: dgomez@mdanderson.org, Gillin, Michael, Liao, Zhongxing, Wei, Caimiao, Lin, Steven H., Swanick, Cameron, Alvarado, Tina, Komaki, Ritsuko, Cox, James D., and Chang, Joe Y. Phase 1 Study of Dose Escalation in Hypofractionated Proton Beam Therapy for Non-Small Cell Lung Cancer. United States: N. p., 2013. Web. doi:10.1016/J.IJROBP.2013.03.035.
Gomez, Daniel R., E-mail: dgomez@mdanderson.org, Gillin, Michael, Liao, Zhongxing, Wei, Caimiao, Lin, Steven H., Swanick, Cameron, Alvarado, Tina, Komaki, Ritsuko, Cox, James D., & Chang, Joe Y. Phase 1 Study of Dose Escalation in Hypofractionated Proton Beam Therapy for Non-Small Cell Lung Cancer. United States. https://doi.org/10.1016/J.IJROBP.2013.03.035
Gomez, Daniel R., E-mail: dgomez@mdanderson.org, Gillin, Michael, Liao, Zhongxing, Wei, Caimiao, Lin, Steven H., Swanick, Cameron, Alvarado, Tina, Komaki, Ritsuko, Cox, James D., and Chang, Joe Y. 2013. "Phase 1 Study of Dose Escalation in Hypofractionated Proton Beam Therapy for Non-Small Cell Lung Cancer". United States. https://doi.org/10.1016/J.IJROBP.2013.03.035.
@article{osti_22224525,
title = {Phase 1 Study of Dose Escalation in Hypofractionated Proton Beam Therapy for Non-Small Cell Lung Cancer},
author = {Gomez, Daniel R., E-mail: dgomez@mdanderson.org and Gillin, Michael and Liao, Zhongxing and Wei, Caimiao and Lin, Steven H. and Swanick, Cameron and Alvarado, Tina and Komaki, Ritsuko and Cox, James D. and Chang, Joe Y.},
abstractNote = {Background: Many patients with locally advanced non-small cell lung cancer (NSCLC) cannot undergo concurrent chemotherapy because of comorbidities or poor performance status. Hypofractionated radiation regimens, if tolerable, may provide an option to these patients for effective local control. Methods and Materials: Twenty-five patients were enrolled in a phase 1 dose-escalation trial of proton beam therapy (PBT) from September 2010 through July 2012. Eligible patients had histologically documented lung cancer, thymic tumors, carcinoid tumors, or metastatic thyroid tumors. Concurrent chemotherapy was not allowed, but concurrent treatment with biologic agents was. The dose-escalation schema comprised 15 fractions of 3 Gy(relative biological effectiveness [RBE])/fraction, 3.5 Gy(RBE)/fraction, or 4 Gy(RBE)/fraction. Dose constraints were derived from biologically equivalent doses of standard fractionated treatment. Results: The median follow-up time for patients alive at the time of analysis was 13 months (range, 8-28 months). Fifteen patients received treatment to hilar or mediastinal lymph nodes. Two patients experienced dose-limiting toxicity possibly related to treatment; 1 received 3.5-Gy(RBE) fractions and experienced an in-field tracheoesophageal fistula 9 months after PBT and 1 month after bevacizumab. The other patient received 4-Gy(RBE) fractions and was hospitalized for bacterial pneumonia/radiation pneumonitis 4 months after PBT. Conclusion: Hypofractionated PBT to the thorax delivered over 3 weeks was well tolerated even with significant doses to the lungs and mediastinal structures. Phase 2/3 trials are needed to compare the efficacy of this technique with standard treatment for locally advanced NSCLC.},
doi = {10.1016/J.IJROBP.2013.03.035},
url = {https://www.osti.gov/biblio/22224525}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 86,
place = {United States},
year = {Mon Jul 15 00:00:00 EDT 2013},
month = {Mon Jul 15 00:00:00 EDT 2013}
}