First Clinical Report of Proton Beam Therapy for Postoperative Radiotherapy for Non-Small-Cell Lung Cancer.
The characteristic Bragg peak of proton beam therapy (PBT) allows for sparing normal tissues beyond the tumor volume that may allow for decreased toxicities associated with postoperative radiation therapy (PORT). Here we report the first institutional experience with proton therapy for PORT in patients with non-small-cell lung cancer (NSCLC) and assess early toxicities and outcomes.



We identified 61 consecutive patients treated from 2011 to 2014 who underwent PORT for locally advanced NSCLC for positive microscopic margins and/or positive N2 lymph nodes (stage III), with 27 patients receiving PBT and 34 receiving intensity-modulated radiation therapy (IMRT).



Median follow-up time was 23.1 months for PBT (2.3-42.0 months) and 27.9 months for IMRT (0.5-87.4 months). The median radiation dose was 50.4 Gy for PBT (50.4-66.6 Gy) and 54 Gy for IMRT (50.0-72.0 Gy). Grade 3 radiation esophagitis was observed in 1 and 4 patients in the PBT and IMRT groups, respectively. Grade 3 radiation pneumonitis was observed in 1 patient in each cohort. Dosimetric analysis revealed a significant decrease in the V5 and mean lung dose (P = .001 and P = .045, respectively). One-year median overall survival and local recurrence-free survival were 85.2% and 82.4% (95% confidence interval, 72.8%-99.7% and 70.5%-96.2%, P = .648) and 92.3% and 93.3% (82.5%-100%, 84.8%-100%, P = .816) for PBT and IMRT cohorts, respectively.



Postoperative PBT in NSCLC is well-tolerated and has similar excellent short-term outcomes when compared with IMRT. Longer follow-up is necessary to determine if PBT has a meaningful improvement over IMRT for PORT.
Department of Radiation Oncology, University of Maryland, Baltimore, MD.
Jill S
JS
Remick
Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA.
Caitlin
C
Schonewolf
Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA.
Peter
P
Gabriel
Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA.
Abigail
A
Doucette
Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA.
William P
WP
Levin
Department of Thoracic Surgery, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA.
John C
JC
Kucharczuk
Department of Thoracic Surgery, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA.
Sunil
S
Singhal
Department of Thoracic Surgery, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA.
Taine T V
TTV
Pechet
Department of Radiation Oncology, University of Washington, Seattle, WA.
Ramesh
R
Rengan
Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA.
Charles B
CB
Simone
Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA. Electronic address: Abigail.Berman@uphs.upenn.edu.
Abigail T
AT
Berman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D004941:Esophagitis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D061766:Proton Therapy / Q000009:adverse effects; D011832:Radiation Injuries; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
Intensity-modulated radiation therapy; Locally advanced lung cancer; Radiation toxicity