Abstract
Simple SummaryWe analyzed the oncologic outcomes and toxicities after intensity-modulated radiation therapy (IMRT) or pencil beam scanning proton therapy (PBSPT) in patients with locally advanced non-small cell lung cancer treated with concurrent chemoradiation therapy. Due to an imbalance in baseline characteristics between IMRT and PBSPT, we used propensity score-based statistical analysis. Regarding radiation therapy planning, PBSPT exhibited superior sparing of the lung, heart, and spinal cord compared to intensity-modulated (photon) radiotherapy in patients with advanced NSCLC. However, PBSPT resulted in higher incidence of grade 3 or more dermatitis and esophagitis compared to IMRT. Despite declined baseline lung function, PBSPT demonstrated a comparable rate of symptomatic radiation pneumonitis compared to IMRT. PBSPT could be an effective and safe treatment technique with comparable locoregional control.This study compared the efficacy and safety of pencil beam scanning proton therapy (PBSPT) versus intensity-modulated (photon) radiotherapy (IMRT) in patients with stage III non-small cell lung cancer (NSCLC). We retrospectively reviewed 219 patients with stage III NSCLC who received definitive concurrent chemoradiotherapy between November 2016 and December 2018. Twenty-five patients (11.4%) underwent PBSPT (23 with single-field optimization) and 194 patients (88.6%) underwent IMRT. Rates of locoregional control (LRC), overall survival, and acute/late toxicities were compared between the groups using propensity score-adjusted analyses. Patients treated with PBSPT were older (median: 67 vs. 62 years) and had worse pulmonary function at baseline (both FEV1 and DLCO) compared to those treated with IMRT. With comparable target coverage, PBSPT exhibited superior sparing of the lung, heart, and spinal cord to radiation exposure compared to IMRT. At a median follow-up of 21.7 (interquartile range: 16.8–26.8) months, the 2-year LRC rates were 72.1% and 84.1% in the IMRT and PBSPT groups, respectively (p = 0.287). The rates of grade ≥ 3 esophagitis were 8.2% and 20.0% after IMRT and PBSPT (p = 0.073), respectively, while corresponding rates of grade ≥ 2 radiation pneumonitis were 28.9% and 16.0%, respectively (p = 0.263). PBSPT appears to be an effective and safe treatment technique even for patients with poor lung function, and it does not jeopardize LRC.
Highlights
The mainstay treatment for locally advanced non-small cell lung cancer (NSCLC)is concurrent chemoradiation therapy (CCRT), with a median survival of 29 months [1].Higher radiation therapy (RT) dose to improve locoregional control (LRC) [2] is often limited given the close proximity to the target volume of critical normal organs.Besides local control, radiation-related toxicities during RT could reduce patients’quality of life and treatment compliance, and some toxicities may be lethal [3]
We retrospectively reviewed the medical records of 219 patients; 194 patients were treated with intensity-modulated radiation therapy (IMRT) (IMRT group) and 25 patients were treated with pencil beam scanning proton therapy (PBSPT) (PBSPT group), respectively
There was a trend toward frequent grade ≥ 3 esophagitis with PBSPT (20.0% vs. 8.2%, p = 0.073, Figure 3); grade ≥ 3 radiation dermatitis was more frequently observed in the PBSPT group than the IMRT group
Summary
The mainstay treatment for locally advanced non-small cell lung cancer (NSCLC)is concurrent chemoradiation therapy (CCRT), with a median survival of 29 months [1].Higher radiation therapy (RT) dose to improve locoregional control (LRC) [2] is often limited given the close proximity to the target volume of critical normal organs.Besides local control, radiation-related toxicities during RT could reduce patients’quality of life and treatment compliance, and some toxicities may be lethal [3]. Is concurrent chemoradiation therapy (CCRT), with a median survival of 29 months [1]. Higher radiation therapy (RT) dose to improve locoregional control (LRC) [2] is often limited given the close proximity to the target volume of critical normal organs. Radiation-related toxicities during RT could reduce patients’. Quality of life and treatment compliance, and some toxicities may be lethal [3]. Beginning typically at the second or third week of CCRT, acute RT-induced esophagitis occurred in. 4–18% of patients, interfering with appropriate nutritional support and inducing longlasting dysphagia [4,5]. Some patients experienced symptomatic radiation pneumonitis (RP), which may affect both quality of life and survival [6]. Owing to promising results from systemic treatments, concerns regarding late-onset toxicity (i.e., cardiotoxicity) have recently increased [6,7]. Meticulous RT planning is needed to maximize the therapeutic ratio
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