Carbon ion radiotherapy for stage I non-small cell lung cancer.
OBJECTIVE
Heavy ion radiotherapy is a promising modality because of its excellent dose localization and high biological effect on tumors. Using carbon beams, a dose escalation study was conducted for the treatment of stage I non-small cell lung cancer (NSCLC) to determine the optimal dose.


METHODS
The first stage phase I/II trial using 18 fractions over 6 weeks for 47 patients and the second one using nine fractions over 3 weeks for 34 patients were conducted by the dose escalation method from 59.4 to 95.4 Gray equivalents (GyE) in incremental steps of 10% and from 68.4 to 79.2 GyE in 5% increments, respectively. The local control and survival rates were obtained using the Kaplan-Meier method.


RESULTS
Radiation pneumonitis at grade III occurred in three of 81 patients, but they fully recovered. This was not a dose-limiting factor. The local control rates in the first and second trials were 64% and 84%, respectively. The total recurrence rate in both trials was 23.2%. The infield local recurrence in the first trial was significantly dependent on carbon dose. The doses greater than 86.4 GyE at 18 fractions and 72 GyE at nine fractions achieved a local control of 90% and 95%, respectively. The 5 year overall and cause-specific survivals in 81 patients were 42% and 60%, respectively.


CONCLUSIONS
With our dose escalation study, the optimum safety and efficacy dose of carbon beams was determined. Carbon beam therapy attained almost the same results as surgery for stage I NSCLC although this was a I/II study.
Miyamoto
Tadaaki
T
Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 9-1 Anagawa, 4-chome, Inage-Ku, Chiba-shi 263-8555, Japan.
Yamamoto
Naoyoshi
N
Nishimura
Hideki
H
Koto
Masashi
M
Tsujii
Hirohiko
H
Mizoe
Jun-etsu
JE
Kamada
Tadashi
T
Kato
Hirotoshi
H
Yamada
Shigeru
S
Morita
Shinroku
S
Yoshikawa
Kyosan
K
Kandatsu
Susumu
S
Fujisawa
Takehiko
T
D000368:Aged; D000369:Aged, 80 and over; D002244:Carbon / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D063193:Heavy Ion Radiotherapy; D020450:Heavy Ions / Q000009:adverse effects; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017564:Radiation Pneumonitis; D020266:Radiotherapy, Conformal; D016019:Survival Analysis; D016896:Treatment Outcome
D002244:Carbon