Abstract
BackgroundLung cancer is frequently complicated by interstitial lung disease (ILD). Treatment protocols for lung cancer patients with ILD have not been established; surgery, chemotherapy, and radiotherapy can all cause acute exacerbation of ILD. This study evaluated the toxicity and efficacy of carbon ion radiotherapy (CIRT) in patients with non-small cell lung cancer (NSCLC) and ILD.MethodsBetween June 2004 and November 2014, 29 patients diagnosed with NSCLC and ILD were treated with CIRT. No patient was eligible for curative surgery or conventional radiotherapy secondary to ILD. Owing to prior symptomology, radiation pneumonitis (RP) and symptom progression pre- and post-treatment were evaluated. The relationships between RP and clinical factors were investigated.ResultsTwenty-eight men and one woman, aged 62 to 90 years old, were followed for 2.7–77.1 months (median: 22.8 months). Single-grade symptomatic progression (grade 2–3) was observed in 4 patients, while 1 patient experiencedtwo-grade progression. Two patients experienced radiation-induced acute exacerbation. Local control at 3 years was 63.3% (72.2% for stage I disease); survival at 3 years was 46.3% (57.2% for stage I disease). Eighteen patients had died by the time of this writing, 10 of lung cancer progression. Radiation pneumonitis post-treatment progression correlated with dosimetric factors of the lungs (V5, V10) and a low pre-treatment serum surfactant protein-D.ConclusionsWe found that CIRT may be useful as a low-risk, curative option for NSCLC patients with ILD, a population that is typically ineligible for conventional therapy. The DVH analysis showed that minimizing the low-dose region is important for reducing the risk of severe RP.Trial registrationNIRS-9404. Registered 1 March 1994.
Highlights
IntroductionTreatment protocols for lung cancer patients with interstitial lung disease (ILD) have not been established; surgery, chemotherapy, and radiotherapy can all cause acute exacerbation of ILD
Lung cancer is frequently complicated by interstitial lung disease (ILD)
We evaluated the toxicity and efficacy of carbon ion radiotherapy (CIRT) for treating non-small cell lung cancer (NSCLC) in patients presenting with ILD
Summary
Treatment protocols for lung cancer patients with ILD have not been established; surgery, chemotherapy, and radiotherapy can all cause acute exacerbation of ILD. This study evaluated the toxicity and efficacy of carbon ion radiotherapy (CIRT) in patients with non-small cell lung cancer (NSCLC) and ILD. Lung cancer (LC) is often associated with interstitial lung disease (ILD). Treatment protocols for ILD-associated LC have not been well-established, as surgery, chemotherapy, and Stereotactic body radiation therapy (SBRT) is a noninvasive cancer treatment, and has proven to be an effective and well-tolerated treatment in numerous studies for early stage LC in medically inoperable patients [10,11,12]. In 1994, the National Institute of Radiological Sciences (NIRS) began exploring carbon-ion radiotherapy (CIRT) as a treatment for non-small cell lung cancer (NSCLC). As reported previously, hypofractionated CIRT has produced excellent local control rates that are comparable to those of surgery or SBRT, with markedly low toxicities [16,17,18,19]
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