Ma Ning-Yi, Chen Jian, Ming Xue, Jiang Guo-Liang, Lu Jiade J, Wu Kai-Liang, Mao Jingfang
Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.
Department of Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.
Front Oncol. 2021 Nov 11;11:766822. doi: 10.3389/fonc.2021.766822. eCollection 2021.
This study aimed to investigate the tolerance and effect of proton plus carbon-ion radiotherapy with concurrent chemotherapy in limited-stage small cell lung cancer using the pencil beam scanning technique.
From March 2017 to April 2020, 25 patients with limited-stage small cell lung cancer treated with combined proton and carbon-ion radiotherapy were analyzed. The primary lesions and involved lymph nodes were irradiated using 2-4 portals. Proton and sequential carbon-ion beams were delivered with a median dose of 67.1 (range, 63-74.8) GyE as fraction doses of 2.0-2.2 GyE with proton beams in 20-23 fractions and 3.0-3.8 GyE with carbon ions in 5-8 fractions. Chemotherapy was delivered concurrently with radiotherapy in all patients.
At the last follow-up, the 2-year overall and locoregional progression-free survival rates were 81.7% and 66.7%, respectively. Radiochemotherapy was well tolerated, with grade 1, 2, and 3 acute toxicities occurring in 12.0%, 68.0%, and 20.0% of patients, respectively. All grade 3 acute toxicities were hematologically related changes. One patient experienced grade 3 acute non-hematological toxicity in the esophagus, and one other patient had grade 3 bronchial obstruction accompanied by obstructive atelectasis as a late side effect.
Proton plus carbon-ion radiotherapy using pencil beam scanning yielded promising survival rates and tolerability in patients with limited-stage small cell lung cancer. A prospective clinical study is warranted to validate the therapeutic efficacy of particle radiotherapy in combination with chemotherapy in limited-stage small cell lung cancer.
本研究旨在使用笔形束扫描技术，探讨质子加碳离子放疗联合同步化疗在局限期小细胞肺癌中的耐受性及疗效。
分析2017年3月至2020年4月间接受质子与碳离子联合放疗的25例局限期小细胞肺癌患者。使用2 - 4个射野对原发灶及受累淋巴结进行照射。质子束和序贯碳离子束的中位剂量为67.1（范围63 - 74.8）GyE，质子束分20 - 23次给予，每次剂量为2.0 - 2.2 GyE，碳离子束分5 - 8次给予，每次剂量为3.0 - 3.8 GyE。所有患者均在放疗期间同步进行化疗。
在末次随访时，2年总生存率和局部区域无进展生存率分别为81.7%和66.7%。放化疗耐受性良好，1级、2级和3级急性毒性反应分别发生在12.0%、68.0%和20.0%的患者中。所有3级急性毒性反应均为血液学相关改变。1例患者出现3级食管急性非血液学毒性反应，另1例患者出现3级支气管阻塞伴阻塞性肺不张这一晚期不良反应。
使用笔形束扫描的质子加碳离子放疗在局限期小细胞肺癌患者中显示出有前景的生存率和耐受性。有必要开展一项前瞻性临床研究，以验证粒子放疗联合化疗在局限期小细胞肺癌中的治疗效果。
