Department of Radiation Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA.
Clin Lung Cancer. 2012 Sep;13(5):352-8. doi: 10.1016/j.cllc.2011.11.008. Epub 2012 Jan 20.
Proton therapy can deliver a more conformal dose distribution than photon radiation and may allow safe dose escalation in stage III lung cancer. Early outcomes are presented here for patients who received proton therapy with concurrent chemotherapy for non-small-cell lung cancer (NSCLC).
Nineteen patients with regionally advanced NSCLC were treated with concurrent chemotherapy (carboplatin and paclitaxel [n = 18]) and proton therapy from August 2008 to April 2010 either with (n = 7) or without (n = 12) induction chemotherapy. Eighteen patients had stage III NSCLC, and 1 patient had stage IIB disease. The median proton therapy dose was 74 cobalt gray equivalent (CGE) in 2 CGE fractions with 18 patients who received ≥70 CGE. Twelve patients also received selective nodal proton therapy to the adjacent uninvolved nodal regions, with a median dose of 40 CGE (range, 40-46 CGE). The patients were routinely evaluated for treatment-related toxicity and disease progression every 3 months, with a history, physical, and computed tomography or positron emission tomography-computed tomography.
The median follow-ups for living patients were 15 and 16 months (range, 7-26 months), respectively. Nonhematologic and hematologic acute grade 3+ toxicity (<90 days) developed in 1 and 4 patients, respectively. Two of 16 patients assessable for late toxicity (≥90 days) developed a significant grade 3+ nonhematologic late toxicity, whereas 1 patient developed a grade 3+ hematologic late toxicity. Local progression was the site of first relapse in one patient.
Mediastinal proton therapy with concomitant chemotherapy was associated with acceptable toxicity. Although encouraging, longer follow-up with more patients is needed to confirm the long-term efficacy of this treatment.
与光子放疗相比，质子治疗能提供更适形的剂量分布，并且可能允许在 III 期肺癌中安全地提高剂量。本文报告了在同期放化疗中接受质子治疗的非小细胞肺癌（NSCLC）患者的早期结果。
19 例局部晚期 NSCLC 患者于 2008 年 8 月至 2010 年 4 月接受同期放化疗（卡铂和紫杉醇，n = 18）和质子治疗，其中 7 例患者接受诱导化疗（n = 7），12 例患者未接受诱导化疗（n = 12）。18 例患者为 III 期 NSCLC，1 例为 IIB 期疾病。质子治疗的中位剂量为 74 钴Gray 等效（CGE），分 2 次 2 CGE 剂量，18 例患者接受的剂量≥70 CGE。12 例患者还接受了相邻未受累淋巴结区域的选择性淋巴结质子治疗，中位剂量为 40 CGE（范围 40-46 CGE）。患者定期接受治疗相关毒性和疾病进展的评估，每 3 个月进行一次病史、体格检查和计算机断层扫描或正电子发射断层扫描-计算机断层扫描。
存活患者的中位随访时间分别为 15 个月和 16 个月（范围 7-26 个月）。1 例患者发生非血液学和血液学急性 3+级毒性（<90 天），4 例患者发生 4 级毒性。16 例可评估晚期毒性（≥90 天）的患者中有 2 例发生明显的 3+级非血液学晚期毒性，1 例发生 3+级血液学晚期毒性。1 例患者局部进展为首次复发部位。
同期放化疗联合纵隔质子治疗的毒性可接受。尽管令人鼓舞，但需要更多患者的更长随访时间来确认这种治疗的长期疗效。
