Abstract
BackgroundIdiopathic pulmonary fibrosis (IPF) is associated with fatal complications after radiotherapy (RT) for lung cancer patients; however, the role of proton therapy to reduce the incidence of life-threatening complications is unclear. Herein, we present the preliminary results of early-stage lung cancer patients having IPF and treated with RT, with a focus on the comparison between X-ray and proton therapy.MethodsFrom January 2010 to October 2017, we retrospectively reviewed the medical records of 264 patients with stage I-II non-small cell lung cancer (NSCLC) treated with definitive RT alone. Ultimately, 30 patients (11.4%) who had underlying IPF were analyzed. Among these, X-ray and proton RT were delivered to 22 and 8 patients, respectively. Treatment-related complications and survival outcomes were compared between X-ray and proton therapy.ResultsThe median follow-up duration was 11 months (range, 2 to 51 months). All living patients were followed-up at least 9 months. Treatment-related death occurred in four patients (18.2%) treated with X-ray but none with proton therapy. Most patients died within one month after the onset of pulmonary symptoms in spite of aggressive treatment. In addition, the 1-year overall survival (OS) rate in patients treated with X-ray and proton was 46.4 and 66.7%, respectively, and patients treated with proton therapy showed a tendency of better survival compared to X-ray (p = 0.081). Especially, in GAP stage II and III subgroups, patients treated with proton therapy showed significantly increased survival outcomes compared to X-ray (1-year OS rate; 50.0% versus 26.4%, p = 0.036) in univariate analysis.ConclusionsRT is associated with serious treatment-related complications in patients with IPF. Proton therapy may be helpful to reduce these acute and fatal complications.Trial registrationretrospectively registered.
Highlights
Idiopathic pulmonary fibrosis (IPF) is associated with fatal complications after radiotherapy (RT) for lung cancer patients; the role of proton therapy to reduce the incidence of life-threatening complications is unclear
Detailed measurements included (1) forced expiratory volume in one second (FEV1), (2) forced vital capacity (FVC), (3) ratio of the two volumes (FEV1/ FVC), (4) diffusing capacity of the lung for carbon monoxide (DLCO), and (5) DLCO divided by alveolar ventilation (DLCO/VA)
Patients who underwent proton therapy showed poorer pulmonary function compared to those undergoing X-ray, the difference was not statistically significant
Summary
Idiopathic pulmonary fibrosis (IPF) is associated with fatal complications after radiotherapy (RT) for lung cancer patients; the role of proton therapy to reduce the incidence of life-threatening complications is unclear. We present the preliminary results of early-stage lung cancer patients having IPF and treated with RT, with a focus on the comparison between X-ray and proton therapy. Pulmonary toxicity is one of the most common treatment-related complications after RT, and can affect the morbidity and mortality of patients with lung cancer [1,2,3,4]. A few clinical results suggest that proton therapy can be performed more safely in patients with IPF than surgery or X-ray treatment [9,10,11]. The role of proton therapy for these vulnerable patients to reduce the incidence of severe RT-related pulmonary complications is still unclear
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