Niedzielski Joshua S, Yang Jinzhong, Mohan Radhe, Titt Uwe, Mirkovic Dragan, Stingo Francesco, Liao Zhongxing, Gomez Daniel R, Martel Mary K, Briere Tina M, Court Laurence E
Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Texas-Houston Health Science Center, Graduate School of Biomedical Science, Houston, Texas.
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Texas-Houston Health Science Center, Graduate School of Biomedical Science, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2017 Nov 15;99(4):1013-1020. doi: 10.1016/j.ijrobp.2017.07.005. Epub 2017 Jul 8.
To determine whether there exists any significant difference in normal tissue toxicity between intensity modulated radiation therapy (IMRT) or proton therapy for the treatment of non-small cell lung cancer.
A total of 134 study patients (n=49 treated with proton therapy, n=85 with IMRT) treated in a randomized trial had a previously validated esophageal toxicity imaging biomarker, esophageal expansion, quantified during radiation therapy, as well as esophagitis grade (Common Terminology Criteria for Adverse Events version 3.0), on a weekly basis during treatment. Differences between the 2 modalities were statically analyzed using the imaging biomarker metric value (Kruskal-Wallis analysis of variance), as well as the incidence and severity of esophagitis grade (χ and Fisher exact tests, respectively). The dose-response of the imaging biomarker was also compared between modalities using esophageal equivalent uniform dose, as well as delivered dose to an isotropic esophageal subvolume.
No statistically significant difference in the distribution of esophagitis grade, the incidence of grade ≥3 esophagitis (15 and 11 patients treated with IMRT and proton therapy, respectively), or the esophageal expansion imaging biomarker between cohorts (P>.05) was found. The distribution of imaging biomarker metric values had similar distributions between treatment arms, despite a slightly higher dose volume in the proton arm (P>.05). Imaging biomarker dose-response was similar between modalities for dose quantified as esophageal equivalent uniform dose and delivered esophageal subvolume dose. Regardless of treatment modality, there was high variability in imaging biomarker response, as well as esophagitis grade, for similar esophageal doses between patients.
There was no significant difference in esophageal toxicity from either proton- or photon-based radiation therapy as quantified by esophagitis grade or the esophageal expansion imaging biomarker.
确定调强放射治疗（IMRT）或质子治疗在非小细胞肺癌治疗中正常组织毒性是否存在显著差异。
在一项随机试验中接受治疗的134名研究患者（49名接受质子治疗，85名接受IMRT）有一个先前已验证的食管毒性成像生物标志物——食管扩张，在放射治疗期间进行量化，以及在治疗期间每周评估食管炎分级（不良事件通用术语标准第3.0版）。使用成像生物标志物度量值（Kruskal-Wallis方差分析）以及食管炎分级的发生率和严重程度（分别为χ检验和Fisher精确检验）对两种治疗方式之间的差异进行统计学分析。还使用食管等效均匀剂量以及向各向同性食管子体积输送的剂量比较了两种治疗方式之间成像生物标志物的剂量反应。
在食管炎分级分布、≥3级食管炎的发生率（分别有15名和11名接受IMRT和质子治疗的患者）或队列之间的食管扩张成像生物标志物方面未发现统计学显著差异（P>0.05）。尽管质子治疗组的剂量体积略高，但成像生物标志物度量值的分布在各治疗组之间具有相似的分布（P>0.05）。对于以食管等效均匀剂量和输送的食管子体积剂量量化的剂量，两种治疗方式之间的成像生物标志物剂量反应相似。无论治疗方式如何，在相似食管剂量的患者之间，成像生物标志物反应以及食管炎分级都存在高度变异性。
通过食管炎分级或食管扩张成像生物标志物量化，基于质子或光子的放射治疗在食管毒性方面没有显著差异。
