High‐dose proton therapy and carbon‐ion therapy for stage I nonsmall cell lung cancer

Iwata, Hiromitsu; Murakami, Masao; Demizu, Yusuke; Miyawaki, Daisuke; Terashima, Kazuki; Niwa, Yasue; Mima, Masayuki; Akagi, Takashi; Hishikawa, Yoshio; Shibamoto, Yuta

doi:10.1002/cncr.24998

Cited by 100 publications

(107 citation statements)

References 36 publications

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“…Hypofractionation with protons and C-ions is under way for NSCLC in several centres. Published TCP data for CPT in NSCLC [39][40][41][42][43][44][45][46] are plotted in Figure 4, along with the curve derived from X-ray SBRT trials. 33,34 CPT TCP are generally consistent with the X-ray SBRT TCP.…”

Section: Hypofractionationmentioning

confidence: 99%

New challenges in high-energy particle radiobiology

Durante

2014

BJR

125

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Densely ionizing radiation has always been a main topic in radiobiology. In fact, a-particles and neutrons are sources of radiation exposure for the general population and workers in nuclear power plants. More recently, high-energy protons and heavy ions attracted a large interest for two applications: hadrontherapy in oncology and space radiation protection in manned space missions. For many years, studies concentrated on measurements of the relative biological effectiveness (RBE) of the energetic particles for different end points, especially cell killing (for radiotherapy) and carcinogenesis (for late effects). Although more recently, it has been shown that densely ionizing radiation elicits signalling pathways quite distinct from those involved in the cell and tissue response to photons. The response of the microenvironment to charged particles is therefore under scrutiny, and both the damage in the target and non-target tissues are relevant. The role of individual susceptibility in therapy and risk is obviously a major topic in radiation research in general, and for ion radiobiology as well. Particle radiobiology is therefore now entering into a new phase, where beyond RBE, the tissue response is considered. These results may open new applications for both cancer therapy and protection in deep space.Biological effects of densely ionizing radiation have been studied since the beginning of radiobiology. As a matter of fact, a-particles deliver the main contribution to the background radiation dose on Earth, owing to inhalation of the indoor radon.1 Neutrons have also been extensively studied because of protection of workers in nuclear power plants; use of fast neutrons in radiotherapy; and of the exposure of the survivors of the atomic bomb in Hiroshima and Nagasaki, where a neutron component was added to g-rays. Bacq and Alexander 2 already elegantly described the radiobiology of a-particles and neutrons in their 1955 seminal book.More recently, radiobiology research has focused on highenergy protons and heavy ions, mostly for two reasons: charged particle therapy (CPT) in oncology and radiation protection in manned space missions. In both cases, charged particles at energies .100 MeV n 21 are involved. The characteristic depth-dose distribution with the sharp Bragg peak at the end of the range can be exploited for killing tumours; on the other hand, densely ionizing radiation can effectively delay tissue morbidity. Notwithstanding the many differences in exposure conditions, CPT and space radiation protection share several research topics, including individual sensitivity, non-targeted effects, late stochastic effects and so forth.3 Research in these fields requires large high-energy accelerators and is often performed by the same research groups with a common interest in particle radiobiology. Research is rapidly moving forward owing to the diffusion of CPT centres in the USA, Europe, and Asia 4 and to the growing interest in manned space exploration, now a priority for all space agencies, 5 but wi...

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Section: Hypofractionationmentioning

confidence: 99%

New challenges in high-energy particle radiobiology

Durante

2014

BJR

125

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“…Considering these advantages, C-ion RT is expected to achieve high local control rates without severe adverse events in several types of tumor. For stage I NSCLC, a number of studies of C-ion RT revealed that its efficacy and safety were comparable to SBRT (8)(9)(10). Despite the high rate of local control in C-ion RT for stage I NSCLC, regional lymph node or distant metastasis are relatively common (8,9).…”

Section: Introductionmentioning

confidence: 99%

Maximum standardized uptake value on FDG-PET predicts survival in stage I non-small cell lung cancer following carbon ion radiotherapy

et al. 2017

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Abstract. The present study (University Hospital Medical Information Network study no. UMIN000003797) aimed to evaluate whether the maximum standardized uptake value (SUV max ) of pretreatment 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is prognostic factor for stage I non-small cell lung cancer (NSCLC) treated with carbon ion radiotherapy (C-ion RT). Patients treated between June 2010 and June 2013 at Gunma University Heavy Ion Medical Center (Maebashi, Japan) on a prospective protocol were included in the present study. Patients with T1a-b and T2a NSCLC were treated with C-ion RT at a dose of 52.8 Gy [relative biological effectiveness (RBE)] and 60.0 Gy (RBE), respectively, in four fractions. Prior to treatment, all patients underwent FDG-PET, in which the SUV max of primary tumors was evaluated. Local control, progression-free survival (PFS), and overall survival (OS) were calculated. A total of 45 patients were analyzed and the median follow-up period was 28.9 months. The 2-year local control, PFS and OS rates for all patients were 93, 78 and 89%, respectively. The mean SUV max of primary tumors was 5.5, and patients were divided into higher (≥5.5) and lower (<5.5) SUV max groups. The 2-year PFS rates were 61 and 89% for the higher and lower SUV max groups, respectively (P=0.01), and the 2-year OS rates for the higher and lower SUV max groups were 76 and 96%, respectively (P=0.01). The higher SUV max group exhibited a significantly worse PFS and OS compared with the lower SUV max group; however, the SUV max was not associated with the local control rate. In total, 2 patients (4%) experienced grade 2 or 3 radiation pneumonitis, with their symptoms improved through conservative treatment. No patients experienced any grade 4 or 5 toxicities. The results of the present study indicate that pretreatment SUV max is a prognostic indicator for outcomes in patients with stage I NSCLC treated with C-ion RT.

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“…PBT has also been used for stage IA/IB NSCLC, but the clinical evidence for efficacy is limited [4,[18][19][20][21][22]. Nihei et al reported the results of PBT for 37 patients with stage I NSCLC.…”

Section: Clinical Results Of Pbt For Early Stage Non-small-cell Lung mentioning

confidence: 99%