Feasibility of carbon‐ion radiotherapy for re‐irradiation of locoregionally recurrent, metastatic, or secondary lung tumors

• Published in: Cancer science 2018-05, Vol.109 (5), p.1562-1569
• Main Authors: Hayashi, Kazuhiko, Yamamoto, Naoyoshi, Karube, Masataka, Nakajima, Mio, Tsuji, Hiroshi, Ogawa, Kazuhiko, Kamada, Tadashi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cancer therapies; Carbon; carbon‐ion radiotherapy; Chemotherapy; Clinical trials; Esophagus; Feasibility Studies; Female; Heavy Ion Radiotherapy - adverse effects; Humans; Lung cancer; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Lungs; Lymphatic system; Male; Medical prognosis; Metastases; Metastasis; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local - radiotherapy; Neoplasms, Second Primary - radiotherapy; Original; Patients; Pneumonitis; Prognosis; Radiation therapy; recurrence; re‐irradiation; Surgery; Toxicity; Tumors
• ISSN: 1347-9032; 1349-7006
• DOI: 10.1111/cas.13555

Intrathoracic recurrence after carbon‐ion radiotherapy for primary or metastatic lung tumors remains a major cause of cancer‐related deaths. However, treatment options are limited. Herein, we report on the toxicity and efficacy of re‐irradiation with carbon‐ion radiotherapy for locoregionally recurrent, metastatic, or secondary lung tumors. Data of 95 patients with prior intrathoracic carbon‐ion radiotherapy who were treated with re‐irradiation with carbon‐ion radiotherapy at our institution between 2006 and 2016 were retrospectively analyzed. Seventy‐three patients (76.8%) had primary lung tumors and 22 patients (23.2%) had metastatic lung tumors. The median dose of initial carbon‐ion radiotherapy was 52.8 Gy (relative biological effectiveness) and the median dose of re‐irradiation was 66.0 Gy (relative biological effectiveness). None of the patients received concurrent chemotherapy. The median follow‐up period after re‐irradiation was 18 months. In terms of grade ≥3 toxicities, one patient experienced each of the following: grade 5 bronchopleural fistula, grade 4 radiation pneumonitis, grade 3 chest pain, and grade 3 radiation pneumonitis. The 2‐year local control and overall survival rates were 54.0% and 61.9%, respectively. In conclusion, re‐irradiation with carbon‐ion radiotherapy was associated with relatively low toxicity and moderate efficacy. Re‐irradiation with carbon‐ion radiotherapy might be an effective treatment option for patients with locoregionally recurrent, metastatic, or secondary lung tumors. Kaplan‐Meier curves of (a) local control and (b) overall survival following re‐irradiation