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Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era

INTRODUCTION: As immunotherapy has improved distant metastasis-free survival (DMFS) in Non-Small Cell Lung Cancer (NSCLC), isolated locoregional recurrences have increased. However, management of locoregional recurrences can be challenging. We report our institutional experience with definitive inte...

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Autores principales: Janopaul-Naylor, James R., Cao, Yichun, McCall, Neal S., Switchenko, Jeffrey M., Tian, Sibo, Chen, Haijian, Stokes, William A., Kesarwala, Aparna H., McDonald, Mark W., Shelton, Joseph W., Bradley, Jeffrey D., Higgins, Kristin A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9888533/
https://www.ncbi.nlm.nih.gov/pubmed/36733369
http://dx.doi.org/10.3389/fonc.2022.1074675
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author Janopaul-Naylor, James R.
Cao, Yichun
McCall, Neal S.
Switchenko, Jeffrey M.
Tian, Sibo
Chen, Haijian
Stokes, William A.
Kesarwala, Aparna H.
McDonald, Mark W.
Shelton, Joseph W.
Bradley, Jeffrey D.
Higgins, Kristin A.
author_facet Janopaul-Naylor, James R.
Cao, Yichun
McCall, Neal S.
Switchenko, Jeffrey M.
Tian, Sibo
Chen, Haijian
Stokes, William A.
Kesarwala, Aparna H.
McDonald, Mark W.
Shelton, Joseph W.
Bradley, Jeffrey D.
Higgins, Kristin A.
author_sort Janopaul-Naylor, James R.
collection PubMed
description INTRODUCTION: As immunotherapy has improved distant metastasis-free survival (DMFS) in Non-Small Cell Lung Cancer (NSCLC), isolated locoregional recurrences have increased. However, management of locoregional recurrences can be challenging. We report our institutional experience with definitive intent re-irradiation using Intensity Modulated Proton Therapy (IMPT). METHOD: Retrospective cohort study of recurrent or second primary NSCLC or LS-SCLC treated with IMPT. Kaplan-Meier method and log-rank test were used for time-to-event analyses. RESULTS: 22 patients were treated from 2019 to 2021. After first course of radiation (median 60 Gy, range 45-70 Gy), 45% received adjuvant immunotherapy. IMPT re-irradiation began a median of 28.2 months (8.8-172.9 months) after initial radiotherapy. The median IMPT dose was 60 GyE (44-60 GyE). 36% received concurrent chemotherapy with IMPT and 18% received immunotherapy after IMPT. The median patient’s IMPT lung mean dose was 5.3 GyE (0.9-13.9 GyE) and 5 patients had cumulative esophagus max dose >100 GyE with 1-year overall survival (OS) 68%, 1-year local control 80%, 1-year progression free survival 45%, and 1-year DMFS 60%. Higher IMPT (HR 1.4; 95% CI 1.1-1.7, p=0.01) and initial radiotherapy mean lung doses (HR 1.3; 95% CI 1.0-1.6, p=0.04) were associated with worse OS. Two patients developed Grade 3 pneumonitis or dermatitis, one patient developed Grade 2 pneumonitis, and seven patients developed Grade 1 toxicity. There were no Grade 4 or 5 toxicities. DISCUSSION: Definitive IMPT re-irradiation for lung cancer can prolong disease control with limited toxicity, particularly in the immunotherapy era.
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spelling pubmed-98885332023-02-01 Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era Janopaul-Naylor, James R. Cao, Yichun McCall, Neal S. Switchenko, Jeffrey M. Tian, Sibo Chen, Haijian Stokes, William A. Kesarwala, Aparna H. McDonald, Mark W. Shelton, Joseph W. Bradley, Jeffrey D. Higgins, Kristin A. Front Oncol Oncology INTRODUCTION: As immunotherapy has improved distant metastasis-free survival (DMFS) in Non-Small Cell Lung Cancer (NSCLC), isolated locoregional recurrences have increased. However, management of locoregional recurrences can be challenging. We report our institutional experience with definitive intent re-irradiation using Intensity Modulated Proton Therapy (IMPT). METHOD: Retrospective cohort study of recurrent or second primary NSCLC or LS-SCLC treated with IMPT. Kaplan-Meier method and log-rank test were used for time-to-event analyses. RESULTS: 22 patients were treated from 2019 to 2021. After first course of radiation (median 60 Gy, range 45-70 Gy), 45% received adjuvant immunotherapy. IMPT re-irradiation began a median of 28.2 months (8.8-172.9 months) after initial radiotherapy. The median IMPT dose was 60 GyE (44-60 GyE). 36% received concurrent chemotherapy with IMPT and 18% received immunotherapy after IMPT. The median patient’s IMPT lung mean dose was 5.3 GyE (0.9-13.9 GyE) and 5 patients had cumulative esophagus max dose >100 GyE with 1-year overall survival (OS) 68%, 1-year local control 80%, 1-year progression free survival 45%, and 1-year DMFS 60%. Higher IMPT (HR 1.4; 95% CI 1.1-1.7, p=0.01) and initial radiotherapy mean lung doses (HR 1.3; 95% CI 1.0-1.6, p=0.04) were associated with worse OS. Two patients developed Grade 3 pneumonitis or dermatitis, one patient developed Grade 2 pneumonitis, and seven patients developed Grade 1 toxicity. There were no Grade 4 or 5 toxicities. DISCUSSION: Definitive IMPT re-irradiation for lung cancer can prolong disease control with limited toxicity, particularly in the immunotherapy era. Frontiers Media S.A. 2023-01-17 /pmc/articles/PMC9888533/ /pubmed/36733369 http://dx.doi.org/10.3389/fonc.2022.1074675 Text en Copyright © 2023 Janopaul-Naylor, Cao, McCall, Switchenko, Tian, Chen, Stokes, Kesarwala, McDonald, Shelton, Bradley and Higgins https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Janopaul-Naylor, James R.
Cao, Yichun
McCall, Neal S.
Switchenko, Jeffrey M.
Tian, Sibo
Chen, Haijian
Stokes, William A.
Kesarwala, Aparna H.
McDonald, Mark W.
Shelton, Joseph W.
Bradley, Jeffrey D.
Higgins, Kristin A.
Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era
title Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era
title_full Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era
title_fullStr Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era
title_full_unstemmed Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era
title_short Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era
title_sort definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9888533/
https://www.ncbi.nlm.nih.gov/pubmed/36733369
http://dx.doi.org/10.3389/fonc.2022.1074675
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