Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiotherapy, Gustave Roussy Cancer Campus, Villejuif, France.
Radiother Oncol. 2019 Jul;136:136-142. doi: 10.1016/j.radonc.2019.03.029. Epub 2019 Apr 17.
BACKGROUND & PURPOSE: We report disease control, survival, and toxicity in patients with advanced inoperable non-small cell lung cancer (NSCLC) receiving concurrent chemotherapy and intensity-modulated proton therapy (IMPT) at a single institution.
All patients were treated with IMPT with concurrent chemotherapy. Endpoints assessed were local, regional, and distant control, disease-free survival (DFS), and overall survival (OS).
Fifty-one patients were enrolled with a median follow-up time of 23.0 months; 39 (76%) were treated with a simultaneous integrated boost to the gross tumor volume (GTV). The median GTV dose was 67.3 CGE and the median CTV dose was 60.0 CGE. Median OS and DFS times were 33.9 months and 12.6 months. The 3-year local control rate was 78.3%. Treatment was well tolerated, with a grade 3 toxicity rate of 18% (9 events: 4 esophagitis, 3 dermatitis, 1 esophageal stricture, and 1 fatigue) and no grade 4 or 5 toxicity. The most common grade 2 toxic effects were esophagitis (22 [43%]), dermatitis (16 [31%]), pain (15 [29%]), and fatigue (14 [27%]).
Treatment of inoperable NSCLC with IMPT and concurrent chemotherapy achieves excellent disease control with tolerable toxicity.
我们报道了在单一机构中，对无法手术的晚期非小细胞肺癌（NSCLC）患者进行同期化疗和强度调制质子治疗（IMPT）的疾病控制、生存和毒性情况。
所有患者均接受 IMPT 同步化疗。评估的终点包括局部、区域和远处控制、无病生存（DFS）和总生存（OS）。
51 例患者入组，中位随访时间为 23.0 个月；39 例（76%）接受了大体肿瘤体积（GTV）同步整合boost 治疗。GTV 的中位剂量为 67.3 CGE，CTV 的中位剂量为 60.0 CGE。中位 OS 和 DFS 时间分别为 33.9 个月和 12.6 个月。3 年局部控制率为 78.3%。治疗耐受性良好，3 级毒性发生率为 18%（9 例：4 例食管炎、3 例皮炎、1 例食管狭窄和 1 例疲劳），无 4 级或 5 级毒性。最常见的 2 级毒性反应是食管炎（22 例[43%]）、皮炎（16 例[31%]）、疼痛（15 例[29%]）和疲劳（14 例[27%]）。
IMPT 和同期化疗治疗无法手术的 NSCLC 可获得极好的疾病控制，且毒性可耐受。
