High Dose (74 GyE) Proton Beam Therapy With Concurrent Chemotherapy for Stage III Non-Small Cell Lung Cancer

Abstract

Purpose/Objective(s)To evaluate the clinical outcome of high-dose (74 Gy RBE) proton beam therapy (PBT) with concurrent chemotherapy for unresectable locally advanced non-small cell lung cancer (NSCLC).Materials/MethodsBetween 2007 and 2013, 31 patients with locally advanced NSCLC were treated with PBT and chemotherapy concurrently. The prescribed dose was 74 Gy RBE to the primary tumor and 66 Gy RBE to the metastatic lymph nodes. Adapted planning was made during the treatment. Cisplatin- or carboplatin-based chemotherapy was used. Twenty-four of 31 patients were men, and the median age was 63 years (range, 40-79 years). The clinical stage was Stage IIIA in 8 patients and Stage IIIB in 23 patients.ResultsAt the last follow-up, 13 of 31 patients were dead of disease, 2 patients were dead of other diseases, 11 patients were alive with disease, and 5 patients were alive without disease. The median follow-up time was 21 months for all patients and 37 months for surviving patients. The 2-year overall survival, disease-specific survival, and progression-free survival rates were 61%, 65%, and 22%, respectively. The median survival time was 39 months. Sixteen patients developed locoregional recurrences at intra-thorax and/or supraclavicular node (inside the field: 12, outside the field: 3, inside and outside the field: 1). The 2-year locoregional control rate was 53%. No Grade 4 or 5 acute and late non-hematologic toxicities were observed. Grade 3 acute dermatitis and esophagitis were seen in 3 and 2 patients, respectively. Three patients experienced Grade 3 radiation pneumonitis.ConclusionHigh-dose PBT with concurrent chemotherapy for locally advanced NSCLC is a safe and effective treatment option. Purpose/Objective(s)To evaluate the clinical outcome of high-dose (74 Gy RBE) proton beam therapy (PBT) with concurrent chemotherapy for unresectable locally advanced non-small cell lung cancer (NSCLC). To evaluate the clinical outcome of high-dose (74 Gy RBE) proton beam therapy (PBT) with concurrent chemotherapy for unresectable locally advanced non-small cell lung cancer (NSCLC). Materials/MethodsBetween 2007 and 2013, 31 patients with locally advanced NSCLC were treated with PBT and chemotherapy concurrently. The prescribed dose was 74 Gy RBE to the primary tumor and 66 Gy RBE to the metastatic lymph nodes. Adapted planning was made during the treatment. Cisplatin- or carboplatin-based chemotherapy was used. Twenty-four of 31 patients were men, and the median age was 63 years (range, 40-79 years). The clinical stage was Stage IIIA in 8 patients and Stage IIIB in 23 patients. Between 2007 and 2013, 31 patients with locally advanced NSCLC were treated with PBT and chemotherapy concurrently. The prescribed dose was 74 Gy RBE to the primary tumor and 66 Gy RBE to the metastatic lymph nodes. Adapted planning was made during the treatment. Cisplatin- or carboplatin-based chemotherapy was used. Twenty-four of 31 patients were men, and the median age was 63 years (range, 40-79 years). The clinical stage was Stage IIIA in 8 patients and Stage IIIB in 23 patients. ResultsAt the last follow-up, 13 of 31 patients were dead of disease, 2 patients were dead of other diseases, 11 patients were alive with disease, and 5 patients were alive without disease. The median follow-up time was 21 months for all patients and 37 months for surviving patients. The 2-year overall survival, disease-specific survival, and progression-free survival rates were 61%, 65%, and 22%, respectively. The median survival time was 39 months. Sixteen patients developed locoregional recurrences at intra-thorax and/or supraclavicular node (inside the field: 12, outside the field: 3, inside and outside the field: 1). The 2-year locoregional control rate was 53%. No Grade 4 or 5 acute and late non-hematologic toxicities were observed. Grade 3 acute dermatitis and esophagitis were seen in 3 and 2 patients, respectively. Three patients experienced Grade 3 radiation pneumonitis. At the last follow-up, 13 of 31 patients were dead of disease, 2 patients were dead of other diseases, 11 patients were alive with disease, and 5 patients were alive without disease. The median follow-up time was 21 months for all patients and 37 months for surviving patients. The 2-year overall survival, disease-specific survival, and progression-free survival rates were 61%, 65%, and 22%, respectively. The median survival time was 39 months. Sixteen patients developed locoregional recurrences at intra-thorax and/or supraclavicular node (inside the field: 12, outside the field: 3, inside and outside the field: 1). The 2-year locoregional control rate was 53%. No Grade 4 or 5 acute and late non-hematologic toxicities were observed. Grade 3 acute dermatitis and esophagitis were seen in 3 and 2 patients, respectively. Three patients experienced Grade 3 radiation pneumonitis. ConclusionHigh-dose PBT with concurrent chemotherapy for locally advanced NSCLC is a safe and effective treatment option. High-dose PBT with concurrent chemotherapy for locally advanced NSCLC is a safe and effective treatment option.