Abstract
The safety and efficacy of carbon-ion radiotherapy for advanced non-small cell lung cancer have not been established. We evaluated the clinical outcomes and dose-volume histogram parameters of carbon-ion radiotherapy compared with photon therapy in T2b–4N0M0 non-small cell lung cancer. Twenty-three patients were treated with carbon-ion radiotherapy between May 2011 and December 2015. Seven, 14, and 2 patients had T2b, T3, and T4, respectively. The median age was 78 (range, 53−91) years, with 22 male patients. There were 12 adenocarcinomas, 8 squamous cell carcinomas, 1 non-small cell lung carcinoma, and 2 clinically diagnosed lung cancers. Eleven patients were operable, and 12 patients were inoperable. Most patients (91%) were treated with carbon-ion radiotherapy of 60.0 Gy relative biological effectiveness (RBE) in 4 fractions or 64.0 Gy (RBE) in 16 fractions. Local control and overall survival rates were calculated. Dose-volume histogram parameters of normal lung and tumor coverages were compared between carbon-ion radiotherapy and photon therapies, including three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT). The median follow-up of surviving patients was 25 months. Three patients experienced local recurrence, and the 2-year local control rate was 81%. During follow-up, 5 patients died of lung cancer, and 1 died of intercurrent disease. The 2-year overall survival rate was 70%. Operable patients had a better overall survival rate compared with inoperable patients (100% vs. 43%; P = 0.04). There was no grade ≥2 radiation pneumonitis. In dose-volume histogram analysis, carbon-ion radiotherapy had a significantly lower dose to normal lung and greater tumor coverage compared with photon therapies. Carbon-ion radiotherapy was effectively and safely performed for T2b–4N0M0 non-small cell lung cancer, and the dose distribution was superior compared with those for photon therapies. A Japanese multi-institutional study is ongoing to prospectively evaluate these patients and establish the use of carbon-ion radiotherapy.
Highlights
Lung cancer is the leading cause of morbidity and mortality worldwide
We evaluated the clinical outcomes and dose-volume histogram parameters of carbon-ion radiotherapy compared with photon therapy in T2b–4N0M0 nonsmall cell lung cancer
We evaluated the clinical outcomes and dose-volume histogram (DVH) parameters of carbon-ion radiotherapy compared with photon therapy for T2b–4N0M0 NSCLC
Summary
Surgical resection is the standard treatment for non-small lung cancer (NSCLC) without distant metastasis [1]. Lung cancer is a disease of the elderly, and it is difficult to treat inoperable patients with locally advanced NSCLC [2]. Treatment for inoperable locally advanced NSCLC without lymph node metastasis has not been established, and the clinical outcomes with radiotherapy alone are unsatisfactory [6]. Carbon-ion radiotherapy is considered a radical non-surgical therapy for achieving high local control rates without severe adverse events [8, 9]. We evaluated the clinical outcomes and dose-volume histogram (DVH) parameters of carbon-ion radiotherapy compared with photon therapy for T2b–4N0M0 NSCLC
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