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Ablative dose proton beam therapy for stage I and recurrent non-small cell lung carcinomas

Ablative dose PBT for NSCLC

Ablativ dosierte Protonentherapie bei Stadium-I- und rekurrierenden nichtkleinzelligen Lungenkarzinomen

Ablativ dosierte Protonentherapie für NSCLC

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Abstract

Purpose

To evaluate the efficacy and safety of ablative dose hypofractionated proton beam therapy (PBT) for patients with stage I and recurrent non-small cell lung carcinoma (NSCLC).

Patients and methods

A total of 55 patients with stage I (n = 42) and recurrent (n = 13) NSCLC underwent hypofractionated PBT and were retrospectively reviewed. A total dose of 50–72 CGE (cobalt gray equivalent) in 5–12 fractions was delivered.

Results

The median follow-up duration was 29 months (range 4–95 months). There were 24 deaths (43.6%) during the follow-up period: 11 died of disease progression and 13 from other causes. Kaplan–Meier overall survival rate (OS) at 3 years was 54.9% and the median OS was 48.6 months (range 4–95 months). Local progression was observed in 7 patients and the median time to local progression was 9.3 months (range 5–14 months). Cumulative actuarial local control rate (LCR), lymph node metastasis-free survival, and distant metastasis-free survival rates at 3 years were 85.4, 78.4, and 76.5%, respectively. Larger tumor diameter was significantly associated with poorer LCR (3-year: 94% for ≤3 cm vs. 65% for >3 cm, p = 0.006) on univariate analysis and also an independent prognostic factor for LCR (HR 6.9, 95% CI = 1.3–37.8, p = 0.026) on multivariate analysis. No grade 3 or 4 treatment-related toxicities developed. One grade 5 treatment-related adverse event occurred in a patient with symptomatic idiopathic pulmonary fibrosis.

Conclusions

Ablative dose hypofractionated PBT was safe and promising for stage I and recurrent NSCLC.

Zusammenfassung

Zweck

Beurteilung von Wirksamkeit und Sicherheit hypofraktionierter Protonentherapie (PBT) mit ablativen Dosen für nichtkleinzellige Lungenkarzinome (NSCLC) im Stadium I und rekurrierende NSCLC.

Methode und Materialien

Retrospektiv wurden insgesamt 55 NSCLC-Patienten (Stadium I: n = 42; rekurrierender Tumor: n = 13), analysiert. Sie waren mit einer Gesamtdosis von 50–72 CGE („cobalt gray equivalent“) in 5–12 Fraktionen behandelt worden.

Ergebnisse

Der Median der Follow-Up-Dauer lag bei 29 Monaten (4–95). Während der Follow-Up-Periode verstarben 24 (43,6%) Patienten, 11 an einem Erkrankungsprogress, 13 an anderen Ursachen. Die 3‑Jahre-Kaplan-Meier-Gesamtüberlebensrate (OS) war 54,9%, der Median lag bei 48,6 Monaten (4–95). Ein lokaler Progress zeigte sich bei 7 Patienten, der Median der Zeit bis zum lokalen Progress lag bei 9,3 Monaten (5–14). Die aktuarische kumulative lokale Kontrollrate (LCR) und die lymphknoten- bzw. die fernmetastasenfreie Überlebensraten betrugen 85,4, 78,4, bzw. 76,5%. Ein größerer Tumordurchmesser war in der univariaten Analyse statistisch signifikant mit einer ungünstigeren LCR assoziiert (3-Jahre: 94% für ≤3 cm vs. 65% für >3 cm, p = 0,006) und erwies sich auch in der multivariaten Analyse als unabhängiger Prognosefaktor für die LCR (HR 6,9, 95%-KI 1,3–37,8, p = 0,026) ist. Therapiebedingte Grad-3- oder -4-Toxizitäten traten nicht auf, bei einem Patienten mit symptomatischer idiopathischer Lungenfibrose kam es zu einer unerwünschten Therapiewirkung Grad 5.

Schlussfolgerung

Die hypofraktionierte PBT mit ablativen Dosen hat sich als sicheres und erfolgversprechendes Therapieverfahren für NSCLC im Stadium I und für rekurrierenden NSCLC erwiesen.

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Acknowledgement

This study was supported by a National Cancer Center Grant (NCCCTS10494).

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Authors and Affiliations

  1. Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea

    Sung Uk Lee MD, Sung Ho Moon MD, Kwan Ho Cho MD, Joo Young Kim MD, Dae Yong Kim MD, Tae Hyun Kim MD, Yang-Gun Suh MD & Yeon-Joo Kim MD

  2. Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea

    Sung Ho Moon MD

  3. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Hong Ryull Pyo MD

  4. Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea

    Sung Ho Moon MD

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Correspondence to Sung Ho Moon MD.

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Conflict of interest

S.U. Lee, S.H. Moon, K.H. Cho, H.R. Pyo, J.Y. Kim, D.Y. Kim, T.H. Kim, Y.-G. Suh, and Y.-J. Kim state, that there are no conflicts of interest.Acknowledgement This study was supported by a National Cancer Center Grant (NCCCTS10494).

The study was performed in accordance with the guidelines of the institutional review board, which waived the requirements of informed consent due to the retrospective nature of this study.

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Lee, S.U., Moon, S.H., Cho, K.H. et al. Ablative dose proton beam therapy for stage I and recurrent non-small cell lung carcinomas. Strahlenther Onkol 192, 649–657 (2016). https://doi.org/10.1007/s00066-016-0985-9

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  • DOI: https://doi.org/10.1007/s00066-016-0985-9

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