Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy: The Mayo Clinic Experience

Nathan Y. Yu, Todd DeWees, Chenbin Liu, Thomas B. Daniels, Jonathan B. Ashman, Staci E. Beamer, Dawn E. Jaroszewski, Helen J Ross, Harshita Paripati, Jean Claude M. Rwigema, Julia X. Ding, Jie Shan, Wei Liu, Steven E. Schild, Terence T. Sio

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Abstract

Purpose: There are very little data available comparing outcomes of intensity-modulated proton therapy (IMPT) to intensity-modulated radiation therapy (IMRT) in patients with locally advanced NSCLC (LA-NSCLC). Methods: Seventy-nine consecutively treated patients with LA-NSCLC underwent definitive IMPT (n = 33 [42%]) or IMRT (n = 46 [58%]) from 2016 to 2018 at our institution. Survival rates were calculated using the Kaplan-Meier method and compared with the log-rank test. Acute and subacute toxicities were graded based on Common Terminology Criteria for Adverse Events, version 4.03. Results: Median follow-up was 10.5 months (range, 1-27) for all surviving patients. Most were stage III (80%), received median radiation therapy (RT) dose of 60 Gy (range, 45-72), and had concurrent chemotherapy (65%). At baseline, the IMPT cohort was older (76 vs 69 years, P < .01), were more likely to be oxygen-dependent (18 vs 2%, P = .02), and more often received reirradiation (27 vs 9%, P = .04) than their IMRT counterparts. At 1 year, the IMPT and IMRT cohorts had similar overall survival (68 vs 65%, P = .87), freedom from distant metastasis (71 vs 68%, P = .58), and freedom from locoregional recurrence (86 vs 69%, P = .11), respectively. On multivariate analyses, poorer pulmonary function and older age were associated with grade +3 toxicities during and 3 months after RT, respectively (both P ≤ .02). Only 5 (15%) IMPT and 4 (9%) IMRT patients experienced grade 3 or 4 toxicities 3 months after RT (P = .47). There was 1 treatment-related death from radiation pneumonitis 6 months after IMRT in a patient with idiopathic pulmonary fibrosis. Conclusions: Compared with IMRT, our early experience suggests that IMPT resulted in similar outcomes in a frailer population of LA-NSCLC who were more often being reirradiated. The role of IMPT remains to be defined prospectively.

Original languageEnglish (US)
JournalAdvances in Radiation Oncology
DOIs
StateAccepted/In press - Jan 1 2019

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Proton Therapy
Non-Small Cell Lung Carcinoma
Radiotherapy
Radiation Pneumonitis
Idiopathic Pulmonary Fibrosis
Terminology
Multivariate Analysis
Survival Rate

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy : The Mayo Clinic Experience. / Yu, Nathan Y.; DeWees, Todd; Liu, Chenbin; Daniels, Thomas B.; Ashman, Jonathan B.; Beamer, Staci E.; Jaroszewski, Dawn E.; Ross, Helen J; Paripati, Harshita; Rwigema, Jean Claude M.; Ding, Julia X.; Shan, Jie; Liu, Wei; Schild, Steven E.; Sio, Terence T.

In: Advances in Radiation Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Yu, Nathan Y. ; DeWees, Todd ; Liu, Chenbin ; Daniels, Thomas B. ; Ashman, Jonathan B. ; Beamer, Staci E. ; Jaroszewski, Dawn E. ; Ross, Helen J ; Paripati, Harshita ; Rwigema, Jean Claude M. ; Ding, Julia X. ; Shan, Jie ; Liu, Wei ; Schild, Steven E. ; Sio, Terence T. / Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy : The Mayo Clinic Experience. In: Advances in Radiation Oncology. 2019.
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abstract = "Purpose: There are very little data available comparing outcomes of intensity-modulated proton therapy (IMPT) to intensity-modulated radiation therapy (IMRT) in patients with locally advanced NSCLC (LA-NSCLC). Methods: Seventy-nine consecutively treated patients with LA-NSCLC underwent definitive IMPT (n = 33 [42{\%}]) or IMRT (n = 46 [58{\%}]) from 2016 to 2018 at our institution. Survival rates were calculated using the Kaplan-Meier method and compared with the log-rank test. Acute and subacute toxicities were graded based on Common Terminology Criteria for Adverse Events, version 4.03. Results: Median follow-up was 10.5 months (range, 1-27) for all surviving patients. Most were stage III (80{\%}), received median radiation therapy (RT) dose of 60 Gy (range, 45-72), and had concurrent chemotherapy (65{\%}). At baseline, the IMPT cohort was older (76 vs 69 years, P < .01), were more likely to be oxygen-dependent (18 vs 2{\%}, P = .02), and more often received reirradiation (27 vs 9{\%}, P = .04) than their IMRT counterparts. At 1 year, the IMPT and IMRT cohorts had similar overall survival (68 vs 65{\%}, P = .87), freedom from distant metastasis (71 vs 68{\%}, P = .58), and freedom from locoregional recurrence (86 vs 69{\%}, P = .11), respectively. On multivariate analyses, poorer pulmonary function and older age were associated with grade +3 toxicities during and 3 months after RT, respectively (both P ≤ .02). Only 5 (15{\%}) IMPT and 4 (9{\%}) IMRT patients experienced grade 3 or 4 toxicities 3 months after RT (P = .47). There was 1 treatment-related death from radiation pneumonitis 6 months after IMRT in a patient with idiopathic pulmonary fibrosis. Conclusions: Compared with IMRT, our early experience suggests that IMPT resulted in similar outcomes in a frailer population of LA-NSCLC who were more often being reirradiated. The role of IMPT remains to be defined prospectively.",
author = "Yu, {Nathan Y.} and Todd DeWees and Chenbin Liu and Daniels, {Thomas B.} and Ashman, {Jonathan B.} and Beamer, {Staci E.} and Jaroszewski, {Dawn E.} and Ross, {Helen J} and Harshita Paripati and Rwigema, {Jean Claude M.} and Ding, {Julia X.} and Jie Shan and Wei Liu and Schild, {Steven E.} and Sio, {Terence T.}",
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T1 - Early Outcomes of Patients With Locally Advanced Non-small Cell Lung Cancer Treated With Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiation Therapy

T2 - The Mayo Clinic Experience

AU - Yu, Nathan Y.

AU - DeWees, Todd

AU - Liu, Chenbin

AU - Daniels, Thomas B.

AU - Ashman, Jonathan B.

AU - Beamer, Staci E.

AU - Jaroszewski, Dawn E.

AU - Ross, Helen J

AU - Paripati, Harshita

AU - Rwigema, Jean Claude M.

AU - Ding, Julia X.

AU - Shan, Jie

AU - Liu, Wei

AU - Schild, Steven E.

AU - Sio, Terence T.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: There are very little data available comparing outcomes of intensity-modulated proton therapy (IMPT) to intensity-modulated radiation therapy (IMRT) in patients with locally advanced NSCLC (LA-NSCLC). Methods: Seventy-nine consecutively treated patients with LA-NSCLC underwent definitive IMPT (n = 33 [42%]) or IMRT (n = 46 [58%]) from 2016 to 2018 at our institution. Survival rates were calculated using the Kaplan-Meier method and compared with the log-rank test. Acute and subacute toxicities were graded based on Common Terminology Criteria for Adverse Events, version 4.03. Results: Median follow-up was 10.5 months (range, 1-27) for all surviving patients. Most were stage III (80%), received median radiation therapy (RT) dose of 60 Gy (range, 45-72), and had concurrent chemotherapy (65%). At baseline, the IMPT cohort was older (76 vs 69 years, P < .01), were more likely to be oxygen-dependent (18 vs 2%, P = .02), and more often received reirradiation (27 vs 9%, P = .04) than their IMRT counterparts. At 1 year, the IMPT and IMRT cohorts had similar overall survival (68 vs 65%, P = .87), freedom from distant metastasis (71 vs 68%, P = .58), and freedom from locoregional recurrence (86 vs 69%, P = .11), respectively. On multivariate analyses, poorer pulmonary function and older age were associated with grade +3 toxicities during and 3 months after RT, respectively (both P ≤ .02). Only 5 (15%) IMPT and 4 (9%) IMRT patients experienced grade 3 or 4 toxicities 3 months after RT (P = .47). There was 1 treatment-related death from radiation pneumonitis 6 months after IMRT in a patient with idiopathic pulmonary fibrosis. Conclusions: Compared with IMRT, our early experience suggests that IMPT resulted in similar outcomes in a frailer population of LA-NSCLC who were more often being reirradiated. The role of IMPT remains to be defined prospectively.

AB - Purpose: There are very little data available comparing outcomes of intensity-modulated proton therapy (IMPT) to intensity-modulated radiation therapy (IMRT) in patients with locally advanced NSCLC (LA-NSCLC). Methods: Seventy-nine consecutively treated patients with LA-NSCLC underwent definitive IMPT (n = 33 [42%]) or IMRT (n = 46 [58%]) from 2016 to 2018 at our institution. Survival rates were calculated using the Kaplan-Meier method and compared with the log-rank test. Acute and subacute toxicities were graded based on Common Terminology Criteria for Adverse Events, version 4.03. Results: Median follow-up was 10.5 months (range, 1-27) for all surviving patients. Most were stage III (80%), received median radiation therapy (RT) dose of 60 Gy (range, 45-72), and had concurrent chemotherapy (65%). At baseline, the IMPT cohort was older (76 vs 69 years, P < .01), were more likely to be oxygen-dependent (18 vs 2%, P = .02), and more often received reirradiation (27 vs 9%, P = .04) than their IMRT counterparts. At 1 year, the IMPT and IMRT cohorts had similar overall survival (68 vs 65%, P = .87), freedom from distant metastasis (71 vs 68%, P = .58), and freedom from locoregional recurrence (86 vs 69%, P = .11), respectively. On multivariate analyses, poorer pulmonary function and older age were associated with grade +3 toxicities during and 3 months after RT, respectively (both P ≤ .02). Only 5 (15%) IMPT and 4 (9%) IMRT patients experienced grade 3 or 4 toxicities 3 months after RT (P = .47). There was 1 treatment-related death from radiation pneumonitis 6 months after IMRT in a patient with idiopathic pulmonary fibrosis. Conclusions: Compared with IMRT, our early experience suggests that IMPT resulted in similar outcomes in a frailer population of LA-NSCLC who were more often being reirradiated. The role of IMPT remains to be defined prospectively.

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