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Proton therapy with chemotherapy well-tolerated in advanced lung cancer
Chang JY. Cancer. 2011;doi:10.1002/cncr.26080.
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The combination of high-dose proton therapy with concurrent chemotherapy improved non-hematologic acute toxicity and late acute toxicity in patients with stage III non–small cell lung cancer, according to a study.
Researchers said median survival time in the prospective phase 2 study was 29.4 months compared with the 21.6 months reported in the Radiation Therapy Oncology Group (RTOG-0117) trial.
In the study, Chang and colleagues recruited 44 patients with unresectable or medically inoperable stage III disease from 2006 to 2009. Patients were assigned to 74 Gy proton therapy administered once daily in 2 Gy fractions 5 days per week along with concurrent carboplatin and paclitaxel.
Patients were evaluated at least once every week during treatment; at 6 weeks after completing proton therapy; every 3 months for the first 2 years after finishing treatment; and every 6 months thereafter. Median follow-up was 19.7 months.
No patient experienced grade-5 toxicity and only five patients (11.4%) developed chemotherapy-related grade-4 toxicities — two instances of weight loss and three cases of hemoglobin.
The most common grade-3 adverse events were dermatitis (11.4%) and esophagitis (11.4%). Additionally, there was one case of grade-3 pneumonitis and one case of grade-3 pulmonary/pleural fistula.
At 1 year, OS was 86% and PFS was 63%. Nine (20.5%) patients recurred within the treated area, but only four (9.1%) of those patients had isolated local failure. Four other patients had first recurrence in regional lymph nodes, but only one developed isolated regional recurrence. Distant metastasis was the most common pattern of failure (43.2%).
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