Suh Yang-Gun, Noh Jae Myoung, Lee Doo Yeul, Kim Tae Hyun, Bayasgalan Unurjargal, Pyo Hongryull, Moon Sung Ho
Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea.
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Cancers (Basel). 2022 Jul 26;14(15):3627. doi: 10.3390/cancers14153627.
Proton beam therapy (PBT) and photon radiotherapy for stage I non-small cell lung cancer (NSCLC) were compared in terms of clinical outcomes and dosimetry. Data were obtained from patients who underwent PBT or photon radiotherapy at two institutions-the only two facilities where PBT is available in the Republic of Korea. Multivariate Cox proportional hazards models and propensity score-matched analyses were used to compare local progression-free survival (PFS) and overall survival (OS). Survival and radiation exposure to the lungs were compared in the matched population. Of 289 patients included in the analyses, 112 and 177 underwent PBT and photon radiotherapy, respectively. With a median follow-up duration of 27 months, the 2-year local PFS and OS rates were 94.0% and 83.0%, respectively. In the multivariate analysis, a biologically effective dose (BED, using α/β = 10 Gy) of ≥125 cobalt gray equivalents was significantly associated with improved local PFS and OS. In the matched analyses, the local PFS and OS did not differ between groups. However, PBT showed significantly lower lung and heart radiation exposure in the mean dose, V5, and V10 than photon radiotherapy. PBT significantly reduced radiation exposure to the heart and lungs without worsening disease control in stage I NSCLC patients.
对质子束治疗（PBT）和光子放疗用于I期非小细胞肺癌（NSCLC）的临床结果和剂量测定进行了比较。数据来自在两个机构接受PBT或光子放疗的患者，这是韩国仅有的两家提供PBT的机构。使用多变量Cox比例风险模型和倾向评分匹配分析来比较局部无进展生存期（PFS）和总生存期（OS）。在匹配人群中比较了生存期和肺部的辐射暴露情况。纳入分析的289例患者中，分别有112例和177例接受了PBT和光子放疗。中位随访时间为27个月，2年局部PFS率和OS率分别为94.0%和83.0%。在多变量分析中，生物学有效剂量（BED，使用α/β = 10 Gy）≥125钴灰当量与局部PFS和OS的改善显著相关。在匹配分析中，两组之间的局部PFS和OS没有差异。然而，PBT在平均剂量、V5和V10方面的肺部和心脏辐射暴露显著低于光子放疗。PBT显著降低了I期NSCLC患者心脏和肺部的辐射暴露，且未使疾病控制情况恶化。
