Long-term outcome of phase I/II prospective study of dose-escalated proton therapy for early-stage non-small cell lung cancer

Publication date: Available online 28 January 2017
Source:Radiotherapy and Oncology
Author(s): Joe Y. Chang, Wencheng Zhang, Ritsuko Komaki, Noah C. Choi, Shen Chan, Daniel Gomez, Michael O'Reilly, Melenda Jeter, Michael Gillin, Xiaorong Zhu, Xiaodong Zhang, Radhe Mohan, Stephen Swisher, Stephen Hahn, James D. Cox
PurposeThe aim of this phase I/II study was to assess the long-term clinical benefits and toxicities of proton beam therapy for medically inoperable early-stage non-small cell lung cancer (NSCLC).Patients and methodsFrom June 2006 to September 2011, 35 patients with medically inoperable T1N0M0 (central or superior location, 12 patients) or T2-3N0M0 (any location, 23 patients) NSCLC were treated with 87.5Gy at 2.5Gy/fraction of proton therapy. Toxicities were scored according to the Common Terminology Criteria for Adverse Events, version 4.0.ResultsThe median follow-up time was 83.1months (95% CI: 69.2–97.1months). For all 35 patients, the 1, 3, and 5-year overall survival rates were 85.7%, 42.9%, and 28.1%, respectively. The 5-year local recurrence-free, regional recurrence-free, and distant metastasis-free survival rates were 85.0%, 89.2%, and 54.4%, respectively. Different T stages had no effect on local and regional recurrence (p=0.499, p=1.00). However, with the increase in T stages, the distant metastasis rate increased significantly (p=0.006). The most common adverse effects were dermatitis (grade 2, 51.4%; grade 3, 2.9%) and radiation pneumonitis (grade 2, 11.4%; grade 3, 2.9%). Other grade 2 toxicities included esophagitis (2.9%), rib fracture (2.9%), heart toxicities (5.7%), and chest wall pain (2.9%).ConclusionsAccording to our long-term follow-up data, proton therapy with ablative doses is well tolerated and effective in medically inoperable early-stage NSCLC. Systemic therapy should be considered to reduce the rate of distant metastasis in cases of T2 and T3 lesions.



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