Chest
Clinical InvestigationsCANCEREffects of Proton and Combined Proton/Photon Beam Radiation on Pulmonary Function in Patients With Resectable but Medically Inoperable Non-small Cell Lung Cancer
Section snippets
Radiation Therapy With Protons
One of the disadvantages of radiation therapy for NSCLC compared to surgical resection is reduced long-term survival, resulting from local failure.5 Radiation Therapy Oncology Group studies15 have indicated that higher doses of radiation, up to 60 Gy, are associated with increased survival. When doses have been increased to between 65 Gy and 70 Gy with conventional radiation, further survival benefits have not been demonstrated, presumably because significant morbidity supervenes after damage
Patient Eligibility Requirements
Between August 1994 and January 1998, 37 patients with resectable but medically inoperable NSCLC were treated at LLUMC, either with proton radiation therapy alone when very poor pulmonary function was present (protocol 1), or with combined photon beam and proton beam therapy (protocol 2). To be included into the pulmonary function substudy, the patients must have agreed to have their PFT performed at the indicated intervals at Loma Linda University. This was believed to be necessary to ensure
Results
One patient withdrew consent to the study after receiving radiation therapy. Of the remaining 24 patients, 10 patients were treated according to protocol 1 and 14 patients were treated according to protocol 2. In protocol 1, nine patients had stage I tumors and one patient had a stage II tumor. In protocol 2, eight patients had stage I tumors, two patients had stage II tumors, and four patients had stage IIIA tumors.
Data at month 1 are available from 21 patients, since 3 patients did not report
Radiation-Induced Lung Damage
Several investigators divide the clinical picture of radiation-induced lung damage into three main phases: (1) an early phase, characterized by a period of subclinical pneumonitis (first month); (2) an intermediate phase, in which acute pneumonitis supervenes (third week to several months); and (3) a late phase, in which fibrosis appears (6 months and later).27 To account for these phases, we selected to perform PFT testing at month 1 (early phase), month 3 (intermediate phase), and months 6 to
Conclusions
Our observations indicate that it is feasible to apply higher-than-conventional doses of radiation at a higher-than-conventional dose per fraction without excess pulmonary toxicity when conformal radiation techniques with protons are used. Due to its demonstrated low pulmonary toxicity, dose escalation and fractionation studies are warranted to define optimal dosing schedules.
Acknowledgment
The authors thank William Preston, EdD, for editorial contributions, Sandy Teichman, BSN, for assistance with manuscript preparation, and Rudolf Fuerres, MA, for assistance in statistical analysis.
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Physics of Particle Beam and Hypofractionated Beam Delivery in NSCLC
2021, Seminars in Radiation OncologyCitation Excerpt :It is possible that all these factors must be accounted for, in order to maximize the clinical benefit of proton therapy. There have also been several observational studies comparing clinical outcomes after protons and photons for NSCLC.45-49 A large retrospective study, based on the National Cancer Database, of all NSCLC patients treated from 2004 to 2012, indicated 22% overall survival (OS) at 5 years for protons compared to 16% for the photon cohort.50
High-dose hypofractionated proton beam radiation therapy is safe and effective for central and peripheral early-stage non-small cell lung cancer: Results of a 12-year experience at loma linda university medical center
2013, International Journal of Radiation Oncology Biology PhysicsProton therapy with concurrent chemotherapy for non-small-cell lung cancer: Technique and early results
2012, Clinical Lung CancerCitation Excerpt :Early clinical studies in stage I non–small-cell lung cancer (NSCLC) treated with proton therapy have reported lower rates of adverse effects compared with photon radiotherapy.12-15 Currently, there are few clinical data that describe the outcomes of patients with locally advanced lung cancer with proton therapy.16-23 Due to the development of new proton therapy centers and their anticipated increasing use in lung cancer, the present study set out to describe the University of Florida Proton Therapy Institute (UFPTI) early experience of treating patients who have regionally advanced lung cancer with proton therapy and provides a detailed description of our current treatment planning strategy.
Lung perfusion imaging can risk stratify lung cancer patients for the development of pulmonary complications after chemoradiation
2008, Journal of Thoracic OncologyProton therapy in lung cancer: Clinical outcomes and technical issues. A systematic review
2008, Radiotherapy and OncologyCitation Excerpt :The articles of the Tsukuba group [30,31] were preceded by a short report regarding the first 14 patients treated as a feasibility test [36]. The reports of LLUMC [28,29] are also corroborated by some studies related to the effects of protons as assessed with radiologic imaging [37], pulmonary function tests [38] and biologic values [39]. Surgery (lobectomy or pneumonectomy) continues to provide the best chance for cure in early-stage patients producing the best reported survival outcomes with a 5-year survival rate of about 60% for stage I [40–42].
Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition)
2007, ChestCitation Excerpt :Local control of the cancer and survival seemed to be higher in patients receiving > 60 to 65 Gy of radiation. Newer techniques for administering radiation therapy may improve overall survival with a reduced risk for lung toxicity.44, 45 Three-dimensional conformal radiotherapy may allow the tolerable administration of up to 84 Gy of radiation with potentially improved survival.46