Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era
IntroductionAs immunotherapy has improved distant metastasis-free survival (DMFS) in Non-Small Cell Lung Cancer (NSCLC), isolated locoregional recurrences have increased. However, management of locoregional recurrences can be challenging. We report our institutional experience with definitive intent...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.1074675/full |
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| author | James R. Janopaul-Naylor Yichun Cao Neal S. McCall Jeffrey M. Switchenko Jeffrey M. Switchenko Sibo Tian Haijian Chen William A. Stokes Aparna H. Kesarwala Mark W. McDonald Joseph W. Shelton Jeffrey D. Bradley Kristin A. Higgins |
| author_facet | James R. Janopaul-Naylor Yichun Cao Neal S. McCall Jeffrey M. Switchenko Jeffrey M. Switchenko Sibo Tian Haijian Chen William A. Stokes Aparna H. Kesarwala Mark W. McDonald Joseph W. Shelton Jeffrey D. Bradley Kristin A. Higgins |
| author_sort | James R. Janopaul-Naylor |
| collection | DOAJ |
| description | IntroductionAs immunotherapy has improved distant metastasis-free survival (DMFS) in Non-Small Cell Lung Cancer (NSCLC), isolated locoregional recurrences have increased. However, management of locoregional recurrences can be challenging. We report our institutional experience with definitive intent re-irradiation using Intensity Modulated Proton Therapy (IMPT).MethodRetrospective cohort study of recurrent or second primary NSCLC or LS-SCLC treated with IMPT. Kaplan-Meier method and log-rank test were used for time-to-event analyses.Results22 patients were treated from 2019 to 2021. After first course of radiation (median 60 Gy, range 45-70 Gy), 45% received adjuvant immunotherapy. IMPT re-irradiation began a median of 28.2 months (8.8-172.9 months) after initial radiotherapy. The median IMPT dose was 60 GyE (44-60 GyE). 36% received concurrent chemotherapy with IMPT and 18% received immunotherapy after IMPT. The median patient’s IMPT lung mean dose was 5.3 GyE (0.9-13.9 GyE) and 5 patients had cumulative esophagus max dose >100 GyE with 1-year overall survival (OS) 68%, 1-year local control 80%, 1-year progression free survival 45%, and 1-year DMFS 60%. Higher IMPT (HR 1.4; 95% CI 1.1-1.7, p=0.01) and initial radiotherapy mean lung doses (HR 1.3; 95% CI 1.0-1.6, p=0.04) were associated with worse OS. Two patients developed Grade 3 pneumonitis or dermatitis, one patient developed Grade 2 pneumonitis, and seven patients developed Grade 1 toxicity. There were no Grade 4 or 5 toxicities.DiscussionDefinitive IMPT re-irradiation for lung cancer can prolong disease control with limited toxicity, particularly in the immunotherapy era. |
| first_indexed | 2024-04-10T22:31:08Z |
| format | Article |
| id | doaj.art-d091abf36c46469abda19b81c829b0db |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-10T22:31:08Z |
| publishDate | 2023-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-d091abf36c46469abda19b81c829b0db2023-01-17T05:07:46ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-01-011210.3389/fonc.2022.10746751074675Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy eraJames R. Janopaul-Naylor0Yichun Cao1Neal S. McCall2Jeffrey M. Switchenko3Jeffrey M. Switchenko4Sibo Tian5Haijian Chen6William A. Stokes7Aparna H. Kesarwala8Mark W. McDonald9Joseph W. Shelton10Jeffrey D. Bradley11Kristin A. Higgins12Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United StatesBiostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, United StatesWinship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United StatesBiostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, United StatesRollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United StatesWinship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United StatesWinship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United StatesWinship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United StatesWinship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United StatesWinship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United StatesWinship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United StatesWinship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United StatesWinship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United StatesIntroductionAs immunotherapy has improved distant metastasis-free survival (DMFS) in Non-Small Cell Lung Cancer (NSCLC), isolated locoregional recurrences have increased. However, management of locoregional recurrences can be challenging. We report our institutional experience with definitive intent re-irradiation using Intensity Modulated Proton Therapy (IMPT).MethodRetrospective cohort study of recurrent or second primary NSCLC or LS-SCLC treated with IMPT. Kaplan-Meier method and log-rank test were used for time-to-event analyses.Results22 patients were treated from 2019 to 2021. After first course of radiation (median 60 Gy, range 45-70 Gy), 45% received adjuvant immunotherapy. IMPT re-irradiation began a median of 28.2 months (8.8-172.9 months) after initial radiotherapy. The median IMPT dose was 60 GyE (44-60 GyE). 36% received concurrent chemotherapy with IMPT and 18% received immunotherapy after IMPT. The median patient’s IMPT lung mean dose was 5.3 GyE (0.9-13.9 GyE) and 5 patients had cumulative esophagus max dose >100 GyE with 1-year overall survival (OS) 68%, 1-year local control 80%, 1-year progression free survival 45%, and 1-year DMFS 60%. Higher IMPT (HR 1.4; 95% CI 1.1-1.7, p=0.01) and initial radiotherapy mean lung doses (HR 1.3; 95% CI 1.0-1.6, p=0.04) were associated with worse OS. Two patients developed Grade 3 pneumonitis or dermatitis, one patient developed Grade 2 pneumonitis, and seven patients developed Grade 1 toxicity. There were no Grade 4 or 5 toxicities.DiscussionDefinitive IMPT re-irradiation for lung cancer can prolong disease control with limited toxicity, particularly in the immunotherapy era.https://www.frontiersin.org/articles/10.3389/fonc.2022.1074675/fulllung cancerre-irradiationproton therapyimmunotherapybronchial necrosisradiation dermatitis |
| spellingShingle | James R. Janopaul-Naylor Yichun Cao Neal S. McCall Jeffrey M. Switchenko Jeffrey M. Switchenko Sibo Tian Haijian Chen William A. Stokes Aparna H. Kesarwala Mark W. McDonald Joseph W. Shelton Jeffrey D. Bradley Kristin A. Higgins Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era Frontiers in Oncology lung cancer re-irradiation proton therapy immunotherapy bronchial necrosis radiation dermatitis |
| title | Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era |
| title_full | Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era |
| title_fullStr | Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era |
| title_full_unstemmed | Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era |
| title_short | Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era |
| title_sort | definitive intensity modulated proton re irradiation for lung cancer in the immunotherapy era |
| topic | lung cancer re-irradiation proton therapy immunotherapy bronchial necrosis radiation dermatitis |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.1074675/full |
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