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Published on: February 6, 2019
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Image-Guided Hypofractionated Proton Therapy in Early-Stage Non-Small Cell Lung Cancer: A Phase 2 Study.
Shivam M Kharod1, R Charles Nichols1, Randal H Henderson1
1Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA.
International Journal of Particle Therapy
|December 4, 2020
Summary
Image-guided proton therapy (PT) shows promising results for early-stage non-small cell lung cancer (NSCLC), offering good local control and survival rates with low toxicity. However, regional nodal and distant relapses require further attention.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Early-stage non-small cell lung cancer (NSCLC) is often treated with stereotactic body radiotherapy.
- Proton therapy (PT) offers potential advantages in reducing treatment-related toxicities.
- Hypofractionated PT combines dose escalation with fewer treatment sessions.
Purpose of the Study:
- To investigate the treatment outcomes and toxicities of image-guided hypofractionated proton therapy (PT) for early-stage non-small cell lung cancer (NSCLC).
- To evaluate the efficacy and safety of this advanced radiation technique in a clinical setting.
Main Methods:
- A cohort of 22 patients with T1-T2 N0M0 NSCLC diagnosed between 2009 and 2018 received image-guided hypofractionated PT.
- Patients were treated with either 48 GyRBE in 4 fractions (peripheral) or 60 GyRBE in 10 fractions (central).
- Daily image guidance and 4-dimensional CT simulation with fiducial markers were employed; toxicity was assessed using CTCAEv4 criteria.
Main Results:
- The median follow-up was 3.5 years. Three- and 5-year overall survival rates were 81% and 49%, respectively.
- Three-year local, regional, and distant control rates were 86%, 85%, and 95%.
- One patient (5%) experienced a late grade 3 bronchial stricture; four patients had in-field recurrences.
Conclusions:
- Image-guided hypofractionated PT demonstrates promising local control and long-term survival for early-stage NSCLC patients.
- The treatment is associated with a low incidence of severe toxicity.
- Regional nodal and distant disease recurrence remain challenges that warrant further investigation.
