TY - JOUR
T1 - Toxicity and Survival After Intensity-Modulated Proton Therapy Versus Passive Scattering Proton Therapy for NSCLC
AU - Gjyshi, Olsi
AU - Xu, Ting
AU - Elhammali, Adnan
AU - Boyce-Fappiano, David
AU - Chun, Stephen G.
AU - Gandhi, Saumil
AU - Lee, Percy
AU - Chen, Aileen B.
AU - Lin, Steven H.
AU - Chang, Joe Y.
AU - Tsao, Anne
AU - Gay, Carl M.
AU - Zhu, X. Ronald
AU - Zhang, Xiaodong
AU - Heymach, John V.
AU - Fossella, Frank V.
AU - Lu, Charles
AU - Nguyen, Quynh Nhu
AU - Liao, Zhongxing
N1 - Funding Information:
Disclosure: Dr. Chun serves as a consultant for AstraZeneca. Dr. Gandhi reports receiving a research grant from AstraZeneca Inc. Dr. Gay reports receiving research grant funding support from AstraZeneca not pertinent to the submitted work. Dr. Liao reports receiving grants from the National Cancer Institute during the conduct of the study. The remaining authors declare no conflict of interest.
Funding Information:
This work was supported in part by grants from the National Cancer Institute ( 1R21 CA222749-01A1 , Proton Therapy to Reduce Heart Damage for Patients Lung Cancer and Cancer Center Support [Core] grant P30 CA016672).
Publisher Copyright:
© 2020 International Association for the Study of Lung Cancer
PY - 2021/2
Y1 - 2021/2
N2 - Objective: Although intensity-modulated radiation therapy (IMPT) is dosimetrically superior to passive scattering proton therapy (PSPT) for locally advanced NSCLC (LA-NSCLC), direct comparisons of clinical outcomes are lacking. Here, we compare toxicity profiles and clinical outcomes after IMPT versus PSPT for LA-NSCLC. Methods: This is a nonrandomized, comparative study of two independent cohorts with LA-NSCLC (stage II–IIIB, stage IV with solitary brain metastasis) treated with concurrent chemotherapy and proton beam therapy. Toxicity (Common Terminology Criteria for Adverse Events version 4.0) and outcomes were prospectively collected as part of a clinical trial (ClinicalTrials.gov identifier NCT00915005) or prospective registry (ClinicalTrials.gov identifier NCT00991094). Results: Of 139 patients, 86 (62%) received PSPT and 53 (38%) IMPT; median follow-up times were 23.9 and 29.0 months, respectively. IMPT delivered lower mean radiation doses to the lungs (PSPT 16.0 Gy versus IMPT 13.0 Gy, p < 0.001), heart (10.7 Gy versus 6.6 Gy, p = 0.004), and esophagus (27.4 Gy versus 21.8 Gy, p = 0.005). Consequently, the IMPT cohort had lower rates of grade 3 or higher pulmonary (17% versus 2%, p = 0.005) and cardiac (11% versus 0%, p = 0.01) toxicities. Six patients (7%) with PSPT and zero patients (0%) with IMPT experienced grade 4 or 5 toxicity. Lower rates of pulmonary (28% versus 3%, p = 0.006) and cardiac (14% versus 0%, p = 0.05) toxicities were observed in the IMPT cohort even after propensity score matching for baseline imbalances. There was also a trend toward longer median overall survival in the IMPT group (23.9 mo versus 36.2 mo, p = 0.09). No difference was found in the 3-year rates of local (25% versus 20%, p = 0.44), local-regional (29% versus 36%, p = 0.56) and distant (52% versus 51%, p = 0.71) recurrences. Conclusions: IMPT is associated with lower radiation doses to the lung, heart, and esophagus, and lower rates of grade 3 or higher cardiopulmonary toxicity; additional clinical studies will be needed to assess the potential differences in survival between the two techniques.
AB - Objective: Although intensity-modulated radiation therapy (IMPT) is dosimetrically superior to passive scattering proton therapy (PSPT) for locally advanced NSCLC (LA-NSCLC), direct comparisons of clinical outcomes are lacking. Here, we compare toxicity profiles and clinical outcomes after IMPT versus PSPT for LA-NSCLC. Methods: This is a nonrandomized, comparative study of two independent cohorts with LA-NSCLC (stage II–IIIB, stage IV with solitary brain metastasis) treated with concurrent chemotherapy and proton beam therapy. Toxicity (Common Terminology Criteria for Adverse Events version 4.0) and outcomes were prospectively collected as part of a clinical trial (ClinicalTrials.gov identifier NCT00915005) or prospective registry (ClinicalTrials.gov identifier NCT00991094). Results: Of 139 patients, 86 (62%) received PSPT and 53 (38%) IMPT; median follow-up times were 23.9 and 29.0 months, respectively. IMPT delivered lower mean radiation doses to the lungs (PSPT 16.0 Gy versus IMPT 13.0 Gy, p < 0.001), heart (10.7 Gy versus 6.6 Gy, p = 0.004), and esophagus (27.4 Gy versus 21.8 Gy, p = 0.005). Consequently, the IMPT cohort had lower rates of grade 3 or higher pulmonary (17% versus 2%, p = 0.005) and cardiac (11% versus 0%, p = 0.01) toxicities. Six patients (7%) with PSPT and zero patients (0%) with IMPT experienced grade 4 or 5 toxicity. Lower rates of pulmonary (28% versus 3%, p = 0.006) and cardiac (14% versus 0%, p = 0.05) toxicities were observed in the IMPT cohort even after propensity score matching for baseline imbalances. There was also a trend toward longer median overall survival in the IMPT group (23.9 mo versus 36.2 mo, p = 0.09). No difference was found in the 3-year rates of local (25% versus 20%, p = 0.44), local-regional (29% versus 36%, p = 0.56) and distant (52% versus 51%, p = 0.71) recurrences. Conclusions: IMPT is associated with lower radiation doses to the lung, heart, and esophagus, and lower rates of grade 3 or higher cardiopulmonary toxicity; additional clinical studies will be needed to assess the potential differences in survival between the two techniques.
KW - Cardiac toxicity
KW - Esophageal toxicity
KW - IMPT
KW - Lung cancer
KW - Proton beam therapy
KW - Pulmonary toxicity
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U2 - 10.1016/j.jtho.2020.10.013
DO - 10.1016/j.jtho.2020.10.013
M3 - Article
C2 - 33198942
AN - SCOPUS:85096169923
SN - 1556-0864
VL - 16
SP - 269
EP - 277
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
IS - 2
ER -