Early Findings on Toxicity of Proton Beam Therapy With Concurrent Chemotherapy for Nonsmall Cell Lung Cancer
Early Findings on Toxicity of Proton Beam Therapy With Concurrent Chemotherapy for Nonsmall Cell Lung Cancer
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DOI：
10.1002/cncr.25848
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发表时间：
2011-07-01
期刊：
影响因子：
6.2
通讯作者：
Cox, James D.
中科院分区：
文献类型：
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作者：
Sejpal, Samir;Komaki, Ritsuko;Cox, James D.
背景：同步放化疗是局部晚期非小细胞肺癌（NSCLC）的标准治疗方法，可导致危及生命的肺炎和食管炎。基于x射线（光子）的放射治疗（PT）通常不能在对近端正常组织没有毒性的情况下给予肿瘤杀伤剂量。我们假设对于大多数非小细胞肺癌患者，质子束治疗比光子PT作为三维适形PT （3D-CRT）或调强PT （IMRT）提供更高的肿瘤剂量和更小的正常组织毒性。方法：我们比较了62例NSCLC患者（治疗期2006-2008）的质子治疗+同步化疗的毒性与类似疾病患者接受3D-CRT+化疗（n = 74，治疗期2001-2003）或IMRT+化疗（n = 66，治疗期2003-2005）的毒性。对总肿瘤体积进行质子治疗，每周静脉注射紫杉醇（50mg /m(2)）和卡铂（曲线下面积2mg /mL/min）。主要终点是毒性（不良事件通用术语标准3.0版）。结果：中位随访时间分别为15.2个月（质子）、17.9个月（3D-CRT）和17.4个月（IMRT）。质子组的中位总辐射剂量为74 Gy(RBE)，而其他组为63 Gy。尽管放疗剂量较高（3D-CRT， 30%和18%；IMRT， 9%和44%；P < 0.05），但质子组严重（>= 3级）肺炎和食管炎发生率（2%和5%）较低
BACKGROUND: Concurrent chemoradiation therapy, the standard of care for locally advanced nonsmall cell lung cancer (NSCLC), can cause life-threatening pneumonitis and esophagitis. X-ray (photon)-based radiation therapy (PT) often cannot be given at tumoricidal doses without toxicity to proximal normal tissues. We hypothesized that proton beam therapy for most patients with NSCLC could permit higher tumor doses with less normal-tissue toxicity than photon PT delivered as 3-dimensional conformal PT (3D-CRT) or intensity-modulated PT (IMRT). METHODS: We compared the toxicity of proton therapy+concurrent chemotherapy in 62 patients with NSCLC (treatment period 2006-2008) with toxicity for patients with similar disease given 3D-CRT+chemotherapy (n = 74; treatment period 2001-2003) or IMRT+chemotherapy (n = 66; treatment period 2003-2005). Proton therapy to the gross tumor volume was given with weekly intravenous paclitaxel (50 mg/m(2)) and carboplatin (area under the curve 2 mg/mL/min). The primary endpoint was toxicity (Common Terminology Criteria for Adverse Events version 3.0). RESULTS: Median follow-up times were 15.2 months (proton), 17.9 months (3D-CRT), and 17.4 months (IMRT). Median total radiation dose was 74 Gy(RBE) for the proton group versus 63 Gy for the other groups. Rates of severe (grade >= 3) pneumonitis and esophagitis in the proton group (2% and 5%) were lower despite the higher radiation dose (3D-CRT, 30% and 18%; IMRT, 9% and 44%; P