Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy: The Mayo Clinic Experience
PURPOSE: There are very little data available comparing outcomes of intensity-modulated proton therapy (IMPT) to intensity-modulated radiation therapy (IMRT) in patients with locally advanced NSCLC (LA-NSCLC). METHODS: Seventy-nine consecutively treated patients with LA-NSCLC underwent definitive IM...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276663/ https://www.ncbi.nlm.nih.gov/pubmed/32529140 http://dx.doi.org/10.1016/j.adro.2019.08.001 |
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author | Yu, Nathan Y. DeWees, Todd A. Liu, Chenbin Daniels, Thomas B. Ashman, Jonathan B. Beamer, Staci E. Jaroszewski, Dawn E. Ross, Helen J. Paripati, Harshita R. Rwigema, Jean-Claude M. Ding, Julia X. Shan, Jie Liu, Wei Schild, Steven E. Sio, Terence T. |
author_facet | Yu, Nathan Y. DeWees, Todd A. Liu, Chenbin Daniels, Thomas B. Ashman, Jonathan B. Beamer, Staci E. Jaroszewski, Dawn E. Ross, Helen J. Paripati, Harshita R. Rwigema, Jean-Claude M. Ding, Julia X. Shan, Jie Liu, Wei Schild, Steven E. Sio, Terence T. |
author_sort | Yu, Nathan Y. |
collection | PubMed |
description | PURPOSE: There are very little data available comparing outcomes of intensity-modulated proton therapy (IMPT) to intensity-modulated radiation therapy (IMRT) in patients with locally advanced NSCLC (LA-NSCLC). METHODS: Seventy-nine consecutively treated patients with LA-NSCLC underwent definitive IMPT (n = 33 [42%]) or IMRT (n = 46 [58%]) from 2016 to 2018 at our institution. Survival rates were calculated using the Kaplan-Meier method and compared with the log-rank test. Acute and subacute toxicities were graded based on Common Terminology Criteria for Adverse Events, version 4.03. RESULTS: Median follow-up was 10.5 months (range, 1-27) for all surviving patients. Most were stage III (80%), received median radiation therapy (RT) dose of 60 Gy (range, 45-72), and had concurrent chemotherapy (65%). At baseline, the IMPT cohort was older (76 vs 69 years, P < .01), were more likely to be oxygen-dependent (18 vs 2%, P = .02), and more often received reirradiation (27 vs 9%, P = .04) than their IMRT counterparts. At 1 year, the IMPT and IMRT cohorts had similar overall survival (68 vs 65%, P = .87), freedom from distant metastasis (71 vs 68%, P = .58), and freedom from locoregional recurrence (86 vs 69%, P = .11), respectively. On multivariate analyses, poorer pulmonary function and older age were associated with grade +3 toxicities during and 3 months after RT, respectively (both P ≤ .02). Only 5 (15%) IMPT and 4 (9%) IMRT patients experienced grade 3 or 4 toxicities 3 months after RT (P = .47). There was 1 treatment-related death from radiation pneumonitis 6 months after IMRT in a patient with idiopathic pulmonary fibrosis. CONCLUSIONS: Compared with IMRT, our early experience suggests that IMPT resulted in similar outcomes in a frailer population of LA-NSCLC who were more often being reirradiated. The role of IMPT remains to be defined prospectively. |
format | Online Article Text |
id | pubmed-7276663 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-72766632020-06-10 Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy: The Mayo Clinic Experience Yu, Nathan Y. DeWees, Todd A. Liu, Chenbin Daniels, Thomas B. Ashman, Jonathan B. Beamer, Staci E. Jaroszewski, Dawn E. Ross, Helen J. Paripati, Harshita R. Rwigema, Jean-Claude M. Ding, Julia X. Shan, Jie Liu, Wei Schild, Steven E. Sio, Terence T. Adv Radiat Oncol Thoracic Cancer PURPOSE: There are very little data available comparing outcomes of intensity-modulated proton therapy (IMPT) to intensity-modulated radiation therapy (IMRT) in patients with locally advanced NSCLC (LA-NSCLC). METHODS: Seventy-nine consecutively treated patients with LA-NSCLC underwent definitive IMPT (n = 33 [42%]) or IMRT (n = 46 [58%]) from 2016 to 2018 at our institution. Survival rates were calculated using the Kaplan-Meier method and compared with the log-rank test. Acute and subacute toxicities were graded based on Common Terminology Criteria for Adverse Events, version 4.03. RESULTS: Median follow-up was 10.5 months (range, 1-27) for all surviving patients. Most were stage III (80%), received median radiation therapy (RT) dose of 60 Gy (range, 45-72), and had concurrent chemotherapy (65%). At baseline, the IMPT cohort was older (76 vs 69 years, P < .01), were more likely to be oxygen-dependent (18 vs 2%, P = .02), and more often received reirradiation (27 vs 9%, P = .04) than their IMRT counterparts. At 1 year, the IMPT and IMRT cohorts had similar overall survival (68 vs 65%, P = .87), freedom from distant metastasis (71 vs 68%, P = .58), and freedom from locoregional recurrence (86 vs 69%, P = .11), respectively. On multivariate analyses, poorer pulmonary function and older age were associated with grade +3 toxicities during and 3 months after RT, respectively (both P ≤ .02). Only 5 (15%) IMPT and 4 (9%) IMRT patients experienced grade 3 or 4 toxicities 3 months after RT (P = .47). There was 1 treatment-related death from radiation pneumonitis 6 months after IMRT in a patient with idiopathic pulmonary fibrosis. CONCLUSIONS: Compared with IMRT, our early experience suggests that IMPT resulted in similar outcomes in a frailer population of LA-NSCLC who were more often being reirradiated. The role of IMPT remains to be defined prospectively. Elsevier 2019-08-21 /pmc/articles/PMC7276663/ /pubmed/32529140 http://dx.doi.org/10.1016/j.adro.2019.08.001 Text en © 2019 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Thoracic Cancer Yu, Nathan Y. DeWees, Todd A. Liu, Chenbin Daniels, Thomas B. Ashman, Jonathan B. Beamer, Staci E. Jaroszewski, Dawn E. Ross, Helen J. Paripati, Harshita R. Rwigema, Jean-Claude M. Ding, Julia X. Shan, Jie Liu, Wei Schild, Steven E. Sio, Terence T. Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy: The Mayo Clinic Experience |
title | Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy: The Mayo Clinic Experience |
title_full | Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy: The Mayo Clinic Experience |
title_fullStr | Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy: The Mayo Clinic Experience |
title_full_unstemmed | Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy: The Mayo Clinic Experience |
title_short | Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy: The Mayo Clinic Experience |
title_sort | early outcomes of patients with locally advanced non-small cell lung cancer treated with intensity-modulated proton therapy versus intensity-modulated radiation therapy: the mayo clinic experience |
topic | Thoracic Cancer |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276663/ https://www.ncbi.nlm.nih.gov/pubmed/32529140 http://dx.doi.org/10.1016/j.adro.2019.08.001 |
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