Clinical Outcomes of Patients With Recurrent Lung Cancer Reirradiated With Proton Therapy on the Proton Collaborative Group and University of Florida Proton Therapy Institute Prospective Registry Studies

Shahed N Badiyan; Michael S Rutenberg; Bradford S Hoppe; Pranshu Mohindra; Gary Larson; William F Hartsell; Henry Tsai; Jing Zeng; Ramesh Rengan; Erica Glass; Sanford Katz; Carlos Vargas; Steven J Feigenberg; Charles B Simone 2nd

doi:10.1016/j.prro.2019.02.008

Clinical Outcomes of Patients With Recurrent Lung Cancer Reirradiated With Proton Therapy on the Proton Collaborative Group and University of Florida Proton Therapy Institute Prospective Registry Studies

Pract Radiat Oncol. 2019 Jul-Aug;9(4):280-288. doi: 10.1016/j.prro.2019.02.008. Epub 2019 Feb 23.

Authors

Affiliations

¹ Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
² University of Florida Proton Therapy Institute, Jacksonville, Florida.
³ Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
⁴ Oklahoma Procure Proton Therapy Center, Oklahoma City, Oklahoma.
⁵ Northwestern Medicine Chicago Proton Center, Warrenville, Illinois.
⁶ New Jersey Procure Proton Therapy Center, Somerset, New Jersey.
⁷ University of Washington and Seattle Cancer Care Alliance Proton Therapy Center, Seattle, Washington.
⁸ Willis-Knighton Proton Therapy Center, Shreveport, Louisiana.
⁹ Mayo Clinic Arizona Proton Therapy Program, Rochester, Minnesota.
¹⁰ Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
¹¹ Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: csimone@nyproton.com.

PMID: 30802618
DOI: 10.1016/j.prro.2019.02.008

Abstract

Purpose: We sought to assess clinical outcomes and toxicities of patients with recurrent lung cancer reirradiated with proton beam therapy (PBT) who were enrolled in 2 prospective registry trials.

Methods and materials: Seventy-nine consecutive patients were reirradiated with PBT at 8 institutions. Conventionally fractionated radiation therapy was used to treat the previous lung cancer in 68% of patients (median equivalent dose in 2 Gy fractions [EQD₂], 60.2 Gy) and hypofractionated/stereotactic body radiation therapy in 32% (median EQD₂, 83.3 Gy). Nine patients (11%) received ≥2 courses of thoracic irradiation before PBT. Eastern Cooperative Oncology Group (ECOG) performance status was 2 to 3 in 13%. Median time from prior radiation therapy to PBT was 19.9 months. PBT was delivered with conventional fractionation in 58% (median EQD₂, 60 Gy), hyperfractionation in 3% (median EQD₂, 62.7 Gy), and hypofractionation in 39% (median EQD₂, 60.4 Gy). Twenty-four patients (30%) received chemotherapy concurrently with PBT.

Results: All patients completed PBT as planned. At a median follow-up of 10.7 months after PBT, median overall survival (OS) and progression-free survival (PFS) were 15.2 months and 10.5 months, respectively. Acute and late grade 3 toxicities occurred in 6% and 1%, respectively. Three patients died after PBT from possible radiation toxicity. On multivariate analysis, ECOG performance status ≤1 was associated with OS (hazard ratio, 0.35; 95% confidence interval, 0.15-0.80; P = .014) and PFS (hazard ratio, 0.32; 95% confidence interval, 0.14-0.73; P = .007).

Conclusions: This is the largest series to date of PBT reirradiation for recurrent lung cancer and indicates that reirradiation with PBT is well tolerated with acceptable toxicity and encouraging efficacy. ECOG performance status was associated with OS and PFS.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / pathology
Carcinoma, Non-Small-Cell Lung / radiotherapy*
Female
Florida
Humans
Lung Neoplasms / pathology
Lung Neoplasms / radiotherapy*
Male
Middle Aged
Prospective Studies
Proton Therapy / methods*
Registries
Universities