Toxicity of Proton Therapy versus Photon Therapy on Salvage Re-Irradiation for Non-Small Cell Lung Cancer.

Kyungmi Yang,Hongryull Pyo,Kwanghyun Jo,Dongryul Oh,Hyunju Shin,Jae Myoung Noh,Sung Ho Moon,Yang-Gun Suh,Eunah Chung,Yong Chan Ahn

doi:10.3390/life12020292

Abstract

This study evaluated the toxicity associated with radiation techniques on curative re-irradiation (re-RT) in patients with thoracic recurrence of non-small cell lung cancer (NSCLC). From 2011 to 2019, we retrospectively reviewed the data of 63 patients with salvage re-RT for in-field or marginal recurrence of NSCLC at two independent institutions. Re-RT techniques using X-ray beams and proton beam therapy (PBT) were also included. Re-RT had a 2-year overall survival (OS) and local progression-free survival of 48.0% and 52.0%, respectively. Fifteen patients experienced grade 3 or higher toxicity after re-RT. The complication rates were 18.2% (4/22) and 26.8% (11/41) in PBT patients and X-ray patients, respectively. Airway or esophageal fistulas occurred in seven patients (11.1%). Fistulas or severe airway obstruction occurred in patients with tumors adjacent to the proximal bronchial tree and esophagus, who underwent hypofractionated radiotherapy (RT) or concurrent chemotherapy, and with a higher dose exposure to the esophagus. In conclusion, salvage re-RT was feasible even in patients with local recurrence within the previous RT field. PBT showed similar survival outcomes and toxicity to those of other techniques. However, thoracic re-RT should be performed carefully considering tumor location and RT regimens such as the fraction size and concurrent chemotherapy.

Highlights

Lung cancer is the most commonly diagnosed cancer and the leading cause of cancerrelated mortality worldwide [1]
Of all lung cancer patients, 85% are diagnosed with non-small cell lung cancer (NSCLC) [2]
We retrospectively reviewed the medical records of 81 patients with locoregional recurrence of NSCLC who underwent salvage re-RT between January 2011 and December 2019 at the Samsung Medical Center and National Cancer Center, which are independent institutions with proton beam therapy (PBT) and X-ray radiotherapy (XRT) facilities

Summary

Introduction

Lung cancer is the most commonly diagnosed cancer and the leading cause of cancerrelated mortality worldwide [1]. Of all lung cancer patients, 85% are diagnosed with non-small cell lung cancer (NSCLC) [2]. The treatment options for NSCLC include surgery, radiotherapy (RT), chemotherapy, or multimodal therapy, depending on the clinical stage and the patient’s condition. After curative treatment, 3–20% of patients experience thoracic recurrence despite the absence of distant metastasis [5]. As a treatment for locoregional recurrence, salvage surgery is recommended for patients with a history of RT. Patients are usually diagnosed with advanced stages or inoperable conditions. In these cases, despite the high risk of treatment-related complications, salvage re-irradiation (re-RT) can be carefully considered [5,6,7]

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Conclusion