He Junyi, Liu Yingxin, Zhang Xiaojing, Li Butuo, Yang Linlin, Wang Haohua, Wang Shijiang, Yu Jinming, Wang Linlin
Cheeloo College of Medicine, Shandong University Cancer Center, Shandong University, Jinan, Shandong, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, 250117, Shandong, China.
Biomark Res. 2024 Aug 26;12(1):90. doi: 10.1186/s40364-024-00642-5.
The use of proton therapy (PT) in early-stage non-small cell lung cancer (ES-NSCLC) remains controversial, with insufficient evidence to determine its superiority over photon therapy (XRT). We conducted a systematic review of PT trials in ES-NSCLC, analyzing dosimetry, efficacy, and safety across to inform clinical decision-making. Our study showed that PT reduced lung and heart dosimetric parameters compared to XRT, with significant differences in lung V5, lung V10 and mean heart dose (MHD). In terms of efficacy, there were no significant differences in 1-year OS, 3-year OS and 3-year PFS between PT and XRT. For toxicity, no significant difference was observed in treatment-related adverse events (TRAEs) and radiation pneumonitis (RP). Single-arm analysis of PT found that V5, V10, V20 of lung and heart V5 were 13.4%, 11.3%, 7.9% and 0.7%, respectively. The mean lung dose and MHD were 4.15 Gy and 0.17 Gy, respectively. The single-arm pooled 1-, 2-, 3- and 5-year OS rates for PT were 95.3%, 82.5%, 81.3% and 69.3%, respectively. PFS rate and local control rate at 3 years were 68.1% and 91.2%, respectively. The rates of TRAEs of grade ≥ 3 and grade ≥ 2 were 2.8% and 19.8%, respectively. The grade ≥ 2 RP occurred at a rate of 8.7%. In conclusion, PT had acceptable efficacy and safety, and was better at protecting organs at risk than XRT in ES-NSCLC. However, the survival and safety benefit of PT was not significant compared to XRT.
在早期非小细胞肺癌（ES-NSCLC）中使用质子治疗（PT）仍存在争议，尚无足够证据确定其优于光子治疗（XRT）。我们对ES-NSCLC的PT试验进行了系统评价，分析剂量测定、疗效和安全性，以指导临床决策。我们的研究表明，与XRT相比，PT降低了肺和心脏的剂量学参数，在肺V5、肺V10和平均心脏剂量（MHD）方面存在显著差异。在疗效方面，PT和XRT在1年总生存期（OS）、3年OS和3年无进展生存期（PFS）方面无显著差异。对于毒性，在治疗相关不良事件（TRAEs）和放射性肺炎（RP）方面未观察到显著差异。PT的单臂分析发现，肺的V5、V10、V20和心脏V5分别为13.4%、11.3%、7.9%和0.7%。平均肺剂量和MHD分别为4.15 Gy和0.17 Gy。PT的单臂汇总1年、2年、3年和5年OS率分别为95.3%、82.5%、81.3%和69.3%。3年的PFS率和局部控制率分别为68.1%和91.2%。≥3级和≥2级TRAEs的发生率分别为2.8%和19.8%。≥2级RP的发生率为8.7%。总之，在ES-NSCLC中，PT具有可接受的疗效和安全性，并且在保护危及器官方面比XRT更好。然而，与XRT相比，PT的生存和安全益处并不显著。
