Long-term outcomes after proton therapy, with concurrent chemotherapy, for stage II–III inoperable non-small cell lung cancer

• Published in: Radiotherapy and oncology 2015-06, Vol.115 (3), p.367-372
• Main Authors: Nguyen, Quynh-Nhu, Ly, Ngoc Bui, Komaki, Ritsuko, Levy, Lawrence B, Gomez, Daniel R, Chang, Joe Y, Allen, Pamela K, Mehran, Reza J, Lu, Charles, Gillin, Michael, Liao, Zhongxing, Cox, James D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carboplatin; Carcinoma, Non-Small-Cell Lung - therapy; Chemoradiotherapy; Disease control; Disease-Free Survival; Esophagitis - etiology; Esophagitis - pathology; Female; Hematology, Oncology and Palliative Medicine; Humans; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Middle Aged; Neoplasm Staging; Paclitaxel; Passive scattering; Proton beam therapy; Proton Therapy - adverse effects; Survival; Treatment Outcome
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2015.05.014

Abstract Purpose We report long-term disease control, survival, and toxicity for patients with locally advanced non-small cell lung cancer prospectively treated with concurrent proton therapy and chemotherapy on a nonrandomized case-only observational study. Methods All patients received passive-scatter proton therapy, planned with 4D-CT–based simulation; all received proton therapy concurrent with weekly chemotherapy. Endpoints were local and distant control, disease-free survival (DFS), and overall survival (OS). Results The 134 patients (21 stage II, 113 stage III; median age 69 years) had a median gross tumor volume (GTV) of 70 cm3 (range, 5–753 cm3 ); 77 patients (57%) received 74 Gy(RBE), and 57 (42%) received 60–72 Gy(RBE) (range, 60–74.1 Gy(RBE)). At a median follow-up time of 4.7 years, median OS times were 40.4 months (stage II) and 30.4 months (stage III). Five-year DFS rates were 17.3% (stage II) and 18.0% (stage III). OS, DFS, and local and distant control rates at 5 years did not differ by disease stage. Age and GTV were related to OS and DFS. Toxicity was tolerable, with 1 grade 4 esophagitis and 16 grade 3 events (2 pneumonitis, 6 esophagitis, 8 dermatitis). Conclusion This report of outcomes after proton therapy for 134 patients indicated that this regimen produced excellent OS with tolerable toxicity.