Toxicity of Proton Therapy versus Photon Therapy on Salvage Re-Irradiation for Non-Small Cell Lung Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Re-Irradiation
2.3. Clinical Outcomes and Statistical Analysis
3. Results
3.1. Patients’ Characteristics
3.2. Clinical Outcomes
3.3. Radiation-related Complications
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Total (N = 63) | XRT (n = 41) | PBT (n = 22) | p-Value |
---|---|---|---|---|
Age, years | ||||
Median (range) | 63 (44–84) | 62 (44–80) | 66 (44–84) | 0.163 |
Sex | ||||
Male | 56 (88.9%) | 35 (85.4%) | 21 (95.5%) | 0.405 |
Female | 7 (11.1%) | 6 (14.6%) | 1 (4.5%) | |
Smoking | ||||
Non-smoker | 11 (17.5%) | 8 (19.5%) | 3 (13.6%) | 0.733 |
Current or ex-moker | 52 (82.5%) | 33 (80.5%) | 19 (86.4%) | |
Histology | ||||
SQ | 41 (65.1%) | 27 (65.9%) | 14 (63.6%) | 0.519 |
AD | 20 (31.7%) | 12 (29.3%) | 8 (36.4%) | |
Others or NOS | 2 (3.2%) | 2 (4.9%) | - | |
CCI | ||||
Median (range) | 4 (1–7) | 3 (1–6) | 4 (1–7) | 0.287 |
Underlying COPD | ||||
No | 51 (81.0%) | 35 (85.4%) | 16 (72.7%) | 0.314 |
Yes | 12 (19.0%) | 6 (14.6%) | 6 (27.3%) | |
Re-RT interval, months | ||||
Median (range) | 15.2 (3.2–44.6) | 15.8 (3.2–44.6) | 14.0 (5.8–28.9) | 0.096 |
ECOG at re-RT | ||||
0–1 | 60 (95.2%) | 41 (100%) | 19 (86.4%) | 0.039 |
2 | 3 (4.8%) | - | 3 (13.6%) | |
FEV1, L | ||||
Median (range) | 2.2 (1.2–3.8) | 2.2 (1.2–3.8) | 2.3 (1.5–2.9) | 0.567 |
DLCO, % | ||||
Median (range) | 72 (25–118) | 72 (25–118) | 67 (25–118) | 0.666 |
Clinical stage at re-RT | ||||
I-II | 30 (47.6%) | 18 (43.9%) | 12 (54.5%) | 0.428 |
III | 33 (52.4%) | 23 (56.1%) | 10 (45.5%) | |
Recurrence at re-RT | ||||
1st | 56 (88.9%) | 37 (90.2%) | 19 (86.4%) | 0.687 |
2nd or more | 7 (11.1%) | 4 (9.3%) | 3 (13.6%) | |
CCRT | ||||
No | 42 (66.7%) | 26 (63.4%) | 16 (72.7%) | 0.578 |
Yes | 21 (33.3%) | 15 (36.6%) | 6 (27.3%) | |
Re-RT technique | ||||
XRT-3D | 23 (36.5%) | 23 (56.1%) | - | - |
XRT-IMRT | 13 (20.6%) | 13 (31.7%) | - | |
XRT-SBRT | 5 (7.9%) | 5 (12.2%) | - | |
PBT-3DPT | 3 (4.8%) | - | 3 (13.6%) | |
PBT-IMPT | 19 (30.2%) | - | 19 (86.4%) |
XRT (n = 41) | PBT (n = 22) | p-Value | |||||
---|---|---|---|---|---|---|---|
Peripheral | Central | Ultracentral | Peripheral | Central | Ultracentral | ||
Trachea | 22 (53.7%) | 3 (7.3%) | 16 (39.0%) | 15 (68.2%) | 3 (13.6%) | 4 (18.2%) | 0.215 |
Proximal bronchi | 22 (53.7%) | 7 (17.1%) | 12 (29.3%) | 12 (54.5%) | 2 (9.1%) | 8 (36.4%) | 0.648 |
Esophagus | 26 (63.4%) | 9 (22.0%) | 6 (14.6%) | 13 (59.1%) | 4 (18.2%) | 5 (22.7%) | 0.712 |
Lung | Esophagus | |||||
---|---|---|---|---|---|---|
Variables | Grades 0–2 | Grades 3–5 | p-Value | Grades 0–2 | Grades 3–5 | p-Value |
Target—trachea location | 0.534 | 1 | ||||
Non-ultracentral | 37 (86.0%) | 6 (14.0%) | 40 (93.0%) | 3 (7.0%) | ||
Ultracentral | 19 (95.0%) | 1 (5.0%) | 18 (90.0%) | 2 (10.0%) | ||
Target—bronchus location | 0.271 | 0.055 | ||||
Non-ultracentral | 40 (93.0%) | 3 (7.0%) | 42 (97.7%) | 1 (2.3%) | ||
Ultracentral | 16 (80.0%) | 4 (20.0%) | 16 (80.0%) | 4 (20.0%) | ||
Target—esophagus location | 1 | <0.001 | ||||
Non-ultracentral | 46 (88.5%) | 6 (11.5%) | 52 (100%) | - | ||
Ultracentral | 10 (90.9%) | 1 (9.1%) | 6 (54.5%) | 5 (45.5%) | ||
CCRT at re-RT | 0.119 | 0.07 | ||||
No | 35 (83.3%) | 7 (16.7%) | 41 (97.6%) | 1 (2.4%) | ||
Yes | 21 (100%) | - | 17 (81.0%) | 4 (19.0%) | ||
Re-RT technique | 0.427 | 0.194 | ||||
PBT | 21 (95.5%) | 1 (4.5%) | 21 (95.5%) | 1 (4.5%) | 0.81 | |
XRT | 35 (85.4%) | 6 (14.6%) | 37 (90.2%) | 4 (9.8%) | ||
rCTV, cc | 81.4 ± 158.6 | 97.0 ± 92.3 | 0.801 | 87.3 ± 157.7 | 34.6 ± 41.4 | 0.074 |
BED10 at re-RT, Gy | 85.3 ± 16.3 | 100.3 ± 34.1 | 0.292 | 87.6 ± 19.9 | 79.9 ± 2.3 | 0.009 |
Re-RT fractions | 22.0 ± 9.5 | 14.0 ± 7.2 | 0.002 | 20.3 ± 9.4 | 30.8 ± 6.1 | 0.017 |
Re-RT fraction size, Gy | 3.8 ± 3.0 | 6.7 ± 5.7 | 0.234 | 4.3 ± 3.5 | 2.2 ± 4.5 | <0.001 |
Cumulative BED10, Gy | 164.4 ± 31.8 | 175.4 ± 28.6 | 0.387 | 167.6 ± 31.9 | 143.3 ± 11.7 | 0.098 |
Lung, Dmean, Gy | 4.5 ± 2.9 | 6.4 ± 4.1 | 0.115 | |||
Lung, V20, % | 7.5 ± 5.4 | 10.4 ± 8.1 | 0.22 | |||
Lung, V5, % | 19.0 ± 13.0 | 24.7 ± 14.1 | 0.283 | |||
Lung, cumulative Dmean, Gy | 14.1 ± 6.2 | 15.5 ± 4.8 | 0.682 | |||
Lung, cumulative V20, % | 22.8 ± 12.2 | 24.8 ± 9.5 | 0.635 | |||
Lung, cumulative V5, % | 46.6 ± 19.3 | 50.3 ± 18.3 | 0.865 | |||
Esophagus, Dmax, Gy | 41.7 ± 23.8 | 67.2 ± 2.5 | <0.001 | |||
Esophagus, Dmean, Gy | 8.6 ± 8.1 | 19.0 ± 7.4 | 0.008 | |||
Esophagus, V50, % | 4.8 ± 9.7 | 21.8 ± 10.7 | <0.001 | |||
Esophagus, cumulative Dmax, Gy | 83.6 ± 33.3 | 123.5 ± 10.4 | <0.001 | |||
Esophagus, cumulative Dmean, Gy | 25.0 ± 14.4 | 42.2 ± 11.3 | 0.012 | |||
Esophagus, cumulative V50, % | 22.3 ± 19.4 | 39.4 ± 9.2 | 0.057 |
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Yang, K.; Suh, Y.-G.; Shin, H.; Pyo, H.; Moon, S.H.; Ahn, Y.C.; Oh, D.; Chung, E.; Jo, K.; Noh, J.M. Toxicity of Proton Therapy versus Photon Therapy on Salvage Re-Irradiation for Non-Small Cell Lung Cancer. Life 2022, 12, 292. https://doi.org/10.3390/life12020292
Yang K, Suh Y-G, Shin H, Pyo H, Moon SH, Ahn YC, Oh D, Chung E, Jo K, Noh JM. Toxicity of Proton Therapy versus Photon Therapy on Salvage Re-Irradiation for Non-Small Cell Lung Cancer. Life. 2022; 12(2):292. https://doi.org/10.3390/life12020292
Chicago/Turabian StyleYang, Kyungmi, Yang-Gun Suh, Hyunju Shin, Hongryull Pyo, Sung Ho Moon, Yong Chan Ahn, Dongryul Oh, Eunah Chung, Kwanghyun Jo, and Jae Myoung Noh. 2022. "Toxicity of Proton Therapy versus Photon Therapy on Salvage Re-Irradiation for Non-Small Cell Lung Cancer" Life 12, no. 2: 292. https://doi.org/10.3390/life12020292