Dose escalation study of proton beam therapy with concurrent chemotherapy for stage <scp>III</scp> non‐small cell lung cancer

Harada, Hideyuki; Fuji, Hiroshi; Ono, Akira; Kenmotsu, Hirotsugu; Naito, Tateaki; Yamashita, Haruo; Asakura, Hirofumi; Nishimura, Tetsuo; Takahashi, Toshiaki; Murayama, Shigeyuki

doi:10.1111/cas.12955

Cited by 14 publications

(7 citation statements)

References 13 publications

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“…To determine the recommended dose of proton beam therapy, a dose escalation study with proton beam therapy was performed. Harada et al reported the results of a dose escalation study of proton beam therapy with concurrent chemotherapy for stage III NSCLC (22). Two prescribed doses of proton beam therapy of 66 Gy (RBE) in 33 fractions and 74 Gy (RBE) in 37 fractions were tested.…”

Section: Discussionmentioning

confidence: 99%

“…Two prescribed doses of proton beam therapy of 66 Gy (RBE) in 33 fractions and 74 Gy (RBE) in 37 fractions were tested. One patient treated with 74 Gy (RBE) developed a grade 3 esophageal fistula, and the recommended dose was determined to be 66 Gy (RBE) (22). Gomez et al conducted a dose escalation study of hypofractionated proton beam therapy for stage III NSCLC (8).…”

Section: Discussionmentioning

confidence: 99%

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A Phase I Study of Hypofractionated Carbon-ion Radiotherapy for Stage III Non-small Cell Lung Cancer

Saitoh

Shirai

Abe

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Phase I Study of Hypofractionated Carbon-ion Radiotherapy for Stage III Non-small Cell Lung Cancer

Saitoh

Shirai

Abe

et al. 2018

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“…Proton therapy has been evaluated for possible clinical advantages in terms of both toxicity and survival ( Table 2) (1, [34][35][36][37][38][39][40][41][42][43]. Several retrospective studies have shown that proton therapy, compared with photon therapy, is associated with reduced lung, esophageal, and hematologic toxicity after concurrent chemoradiation, with acceptable rates of tumor control and survival (44).…”

Section: Locally Advanced Nsclcmentioning

confidence: 99%

Particle therapy in non-small cell lung cancer

Liao¹,

Simone²

2018

Transl. Lung Cancer Res.

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The finite range of proton beams in tissues offers unique dosimetric advantages that theoretically allow the dose to the target to be escalated while minimizing exposure of surrounding tissues and thereby minimizing radiation-induced toxicity. These theoretical advantages have led to widespread adoption of proton therapy around the world for a wide variety of tumors at different anatomic sites. Many treatment-planning comparisons have shown that proton therapy has substantial dosimetric advantages over conventional photon (X-ray) radiation therapy. However, given the typically significant difference in cost between proton therapy versus conventional photon therapy, strong evidence of proton therapy's clinical benefits in terms of toxicity and survival is warranted. Some findings from retrospective studies, single-arm prospective studies, and a very few randomized clinical trials comparing these modalities are beginning to emerge. In this review, we examine the available data on proton therapy for (non-small cell lung cancer NSCLC). We begin by discussing the unique challenges involved in treating moving targets with significant tissue heterogeneity and the technologic efforts underway to overcome these challenges. We then discuss the rationale for minimizing normal tissue toxicity, particularly pulmonary, cardiac, and hematologic toxicity, within the context of previously unsuccessful attempts at dose escalation for lung cancer. Finally, we explore strategies for accelerating the development of trials aimed at measuring meaningful clinical endpoints and for maximizing the value of proton therapy by personalizing its use for individual patients.

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“…Although an increasing number of studies investigating the use of PBT in locally advanced NSCLC have emerged over the last decade, very few have used PBS [ 17 ], the vast majority utilising passively scattered protons [ [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ]. From limited studies that do exist, PBS is suggested to better spare OARs [ 12 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Retrospective Planning Study of Patients with Superior Sulcus Tumours Comparing Pencil Beam Scanning Protons to Volumetric-Modulated Arc Therapy

et al. 2021

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Aims Twenty per cent of patients with non-small cell lung cancer present with stage III locally advanced disease. Precision radiotherapy with pencil beam scanning (PBS) protons may improve outcomes. However, stage III is a heterogeneous group and accounting for complex tumour motion is challenging. As yet, it remains unclear as to whom will benefit. In our retrospective planning study, we explored if patients with superior sulcus tumours (SSTs) are a select cohort who might benefit from this treatment. Materials and methods Patients with SSTs treated with radical radiotherapy using four-dimensional planning computed tomography between 2010 and 2015 were identified. Tumour motion was assessed and excluded if greater than 5 mm. Photon volumetric-modulated arc therapy (VMAT) and PBS proton single-field optimisation plans, with and without inhomogeneity corrections, were generated retrospectively. Robustness analysis was assessed for VMAT and PBS plans involving: (i) 5 mm geometric uncertainty, with an additional 3.5% range uncertainty for proton plans; (ii) verification plans at maximal inhalation and exhalation. Comparative dosimetric and robustness analyses were carried out. Results Ten patients were suitable. The mean clinical target volume D95 was 98.1% ± 0.4 (97.5–98.8) and 98.4% ± 0.2 (98.1–98.9) for PBS and VMAT plans, respectively. All normal tissue tolerances were achieved. The same four PBS and VMAT plans failed robustness assessment. Inhomogeneity corrections minimally impacted proton plan robustness and made it worse in one case. The most important factor affecting target coverage and robustness was the clinical target volume entering the spinal canal. Proton plans significantly reduced the mean lung dose (by 21.9%), lung V5, V10, V20 (by 47.9%, 36.4%, 12.1%, respectively), mean heart dose (by 21.4%) and thoracic vertebra dose (by 29.2%) ( P < 0.05). Conclusions In this planning study, robust PBS plans were achievable in carefully selected patients. Considerable dose reductions to the lung, heart and thoracic vertebra were possible without compromising target coverage. Sparing these lymphopenia-related organs may be particularly important in this era of immunotherapy.

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Dose escalation study of proton beam therapy with concurrent chemotherapy for stage III non‐small cell lung cancer

Cited by 14 publications

References 13 publications

A Phase I Study of Hypofractionated Carbon-ion Radiotherapy for Stage III Non-small Cell Lung Cancer

A Phase I Study of Hypofractionated Carbon-ion Radiotherapy for Stage III Non-small Cell Lung Cancer

Particle therapy in non-small cell lung cancer

Retrospective Planning Study of Patients with Superior Sulcus Tumours Comparing Pencil Beam Scanning Protons to Volumetric-Modulated Arc Therapy

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