High-Risk Non-Small Cell Lung Cancer Treated With Active Scanning Proton Beam Radiation Therapy and Immunotherapy

Area of Science:

• Oncology
• Radiation Oncology
• Medical Physics

Background:

• Non-small cell lung cancer (NSCLC) poses a significant challenge, especially in patients with comorbidities limiting conventional therapy.
• Advances in radiation therapy, such as particle therapy, aim to expand the therapeutic window for these patients.

Purpose of the Study:

• To evaluate the feasibility and outcomes of using proton beam therapy (PBT) with curative intent combined with immunotherapy for high-risk NSCLC patients.
• To assess survival rates and toxicity profiles in this challenging patient cohort.

Main Methods:

• A cohort of 29 high-risk NSCLC patients, often ineligible for conventional radiotherapy due to cardiopulmonary dysfunction or disease characteristics, were treated with pencil beam scanning proton beam therapy (PBS-PBT).
• Patients received definitive PBS-PBT, typically 6000 cGy in 30 fractions, often with concurrent chemotherapy, followed by immunotherapy.
• Toxicity was assessed using CTCAE v5.0, and survival outcomes were analyzed using the Kaplan-Meier method.

Main Results:

• The majority of patients were high-risk due to severe cardiopulmonary dysfunction.
• The treatment was associated with a low rate of acute grade 3 toxicities (esophagitis, dyspnea, cough), with no grade 4 or higher events observed.
• Two-year progression-free survival (PFS) and overall survival (OS) were estimated at 51% and 67%, respectively, with rare high-grade pneumonitis.

Conclusions:

• Radical PBS-PBT in combination with immunotherapy is a feasible treatment strategy for carefully selected high-risk NSCLC patients.
• Multidisciplinary evaluation and rigorous follow-up are crucial for successful implementation of this advanced radiotherapy technique.