In Regard to Nantavithya et al
To the Editor: We read the interesting results from a phase 2 randomized study comparing the toxicity and efficacy of stereotactic body proton therapy (SBPT) and stereotactic body radiation therapy (SBRT) for high-risk medically inoperable early-stage non-small cell lung cancer (NSCLC) by Nantavithya et al (1). Although their study was closed early because of poor accrual and insurance issues, a total of 19 patients receiving 50 Gy (relative biologic effectiveness) in 4 fractions were included for analysis.
Conclusion We observed a significant increase in global lung inflammation bilaterally as measured by quantification of PG. However, no significant change in global lung inflammation was noted after proton therapy. Future larger studies are needed to determine whether this difference correlates with lower risks of radiation pneumonitis in NSCLC patients treated with proton therapy.
Radiation therapy with concurrent chemotherapy is the recommended treatment for patients with locally advanced inoperable non-small cell lung cancer (NSCLC). Unfortunately, local and distant relapses are common, and the median survival time is only about 20 –30 months . Moreover, cardiopulmonary disease is common in such patients, which can make concurrent chemoradiotherapy difficult to tolerate . More effective modalities that allow systemic and local therapies to be combined can improve outcomes.
We report the early clinical outcomes and toxicities of intensity-modulated proton therapy (IMPT) vs. intensity-modulated radiation therapy (IMRT) in patients with locally-advanced NSCLC.
We explored spatial dose patterns associated with symptomatic radiation pneumonitis (RP) in patients with non-small-cell lung cancer given either intensity-modulated photon therapy or passive scattering proton therapy. A dose distribution analysis highlighted regional dose differences associated with both RP status and treatment modality, showing that regions spared with protons are complementary to those correlated with RP; these results can be useful for clinical practice and for designing future trials to minimize RP.
Opinion statementNon-small cell lung cancer (NSCLC) accounts for 85% of new lung cancer cases and has 5-year survival rates ranging from 92% in early-stage disease to as low as 13% in locally advanced cases. Radiation therapy is a key component in the treatment repertoire for NSCLC, where it is currently used alone or in combinations with chemotherapy and surgery. Despite the broad use of modern photon radiation techniques, as many as 25% of patients experience isolated locoregional recurrences, and toxicity has been proven to be a limiting factor in many cases. Proton beam therapy (PBT) has emerged as a potential solution...
This article reviews pertinent studies evaluating the use of IMRT and proton therapy in locally advanced NSCLC, and outlines challenges, indications for use, and areas for future research. PMID: 30206493 [PubMed]
Authors: Molitoris JK, Diwanji T, Snider JW, Mossahebi S, Samanta S, Badiyan SN, Simone CB, Mohindra P Abstract The development of advanced radiation technologies, including intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and proton therapy, has resulted in increasingly conformal radiation treatments. Recent evidence for the importance of minimizing dose to normal critical structures including the heart and lungs has led to incorporation of these advanced treatment modalities into radiation therapy (RT) for non-small cell lung cancer (NSCLC). While such technologies have all...
We compared differences in patterns of locoregional failure, and the influence of adaptive planning on those patterns, in patients who received passive scattering proton therapy (PSPT) versus intensity modulated photon therapy (IMRT) for non-small cell lung cancer.
We compared differences in patterns of local-regional failure, and the influence of adaptive planning on those patterns, for 212 patients given passively scattered proton therapy (PSPT) or intensity-modulated radiation therapy (IMRT), both with concurrent chemotheapy, for non-small cell lung cancer. No differences in patterns of local, marginal, or regional failure were found between treatment groups, and use of adaptive planning (or not) did not influence failure patterns.
Abstract In this review, we discuss the different radiation delivery techniques available to treat non-small cell lung cancer, typical radiologic manifestations of conventional radiotherapy, and different patterns of lung injury and temporal evolution of the newer radiotherapy techniques. More sophisticated techniques include intensity-modulated radiotherapy, stereotactic body radiotherapy, proton therapy, and respiration-correlated computed tomography or 4-dimensional computed tomography for radiotherapy planning. Knowledge of the radiation treatment plan and technique, the completion date of radiotherapy, and th...