Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023;9(1):63-74.

Safety and efficacy of stereotactic body proton therapy for high-risk lung tumors

Matthew T McMillan  1 , Annemarie F Shepherd  1   2 , Minglei Kang  2 , Liyong Lin  3 , Narek Shaverdian  1 , Abraham J Wu  1 , Daphna Y Gelblum  1 , Nitin Ohri  2   4 , Stanislav Lazarev  2   5 , Lee Xu  2 , Arpit M Chhabra  2   5 , Shaakir Hasan  2   4 , J Isabelle Choi  1   2 , Daniel R Gomez  1 , Andreas Rimner  1 , Haibo Lin  1   2   4 , Charles B Simone  1   2
Affiliations

Safety and efficacy of stereotactic body proton therapy for high-risk lung tumors

Matthew T McMillan et al. J Radiosurg SBRT. 2023.

Abstract

Purpose: Stereotactic body proton therapy (SBPT) is an emerging treatment strategy for lung tumors that aims to combine the excellent local control benefits of ultra-hypofractionation with the physical advantages of protons, which reduce the integral dose to organs at risk (OARs) compared to photons. To date, however, very little data delivering SBPT in 5 or fewer fractions to lung tumors have been reported. Given that photon stereotactic body radiation therapy can struggle to deliver ablative doses to high-risk tumors (i.e., central/ultra-central location, prior in-field radiation, tumor size >5 cm, or the presence of severe pulmonary comorbidities) while adhering to OAR dose constraints, we hypothesized that SBPT would be an effective alternative for patients with high-risk tumors.

Methods and materials: Twenty-seven high-risk patients with 29 lung tumors treated with SBPT at the New York Proton Center between December 2019 and November 2022 were retrospectively identified. Patients were divided into three major subgroups: early-stage non-small cell lung cancer (NSCLC), locally recurrent NSCLC, and metastatic cancer from lung cancer or other histologies. Patient characteristics were reported using descriptive statistics, actuarial methods were used to quantify disease control rates, and toxicities were scored using CTCAE v 5.0.

Results: The most common high-risk indications for SBPT were central/ultra-central tumor location (69.0%), severe COPD (48.1%), reirradiation (44.4%), significant pulmonary fibrosis (22.2%), and large tumor size > 5 cm (18.5%). In total, 96.6% of tumors were fully covered by the prescription dose without compromising target coverage. Three-year actuarial rates of local control for early-stage NSCLC, locally recurrent NSCLC, and metastatic patients were 89%, 100%, and 43%, respectively. Three-year actuarial rates of regional control were 89%, 67%, and 86%. Three-year actuarial rates of distant metastasis-free survival were 79%, 100%, and 0%. Two patients (7.4%), both of whom had clinically significant baseline interstitial lung disease and pre-treatment continuous oxygen demand, experienced grade ≥2 pulmonary toxicity (1 grade 3, 1 grade 5). There were no acute or late grade ≥2 toxicities related to esophagitis, cardiac injury, airway injury, pulmonary fibrosis, bronchopulmonary hemorrhage or brachial plexopathy.

Conclusions: In the largest study of proton SBRT reported to date, SBPT has a favorable toxicity profile while being an effective approach for treating most high-risk tumors without requiring dose de-escalation or compromising tumor coverage and warrants further investigation.

Keywords: Proton therapy; lung cancer; pencil beam scanning; stereotactic ablative radiotherapy; stereotactic body radiation therapy; thoracic malignancies.

PubMed Disclaimer

Conflict of interest statement

Authors’ disclosure of potential conflicts of interest Dr Simone has received an honorarium from Varian Medical Systems and is Chair of the Particle Therapy Work Group of NRG Oncology. Dr. Liyong Lin is the cofounder of Radiotherapy Biological Optimization Solutions and the chair of proton SBRT Work Group of NRG Oncology. Other authors have nothing to disclose.

References

    1. Videtic GMM, Donington J, Giuliani M, Heinzerling J, Karas TZ, Kelsey CR, Lally BE, Latzka K, Lo SS, Moghanaki D, Movsas B, Rimner A, Roach M, Rodrigues G, Shirvani SM, Simone CB, Timmerman R, Daly ME. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline Pract Radiat Oncol 2017. Sep75295-301 - PubMed
    1. Simone CB, Bogart JA, Cabrera AR, Daly ME, DeNunzio NJ, Detterbeck F, Faivre-Finn C, Gatschet N, Gore E, Jabbour SK, Kruser TJ, Schneider BJ, Slotman B, Turrisi A, Wu AJ, Zeng J, Rosenzweig KE. Radiation therapy for small cell lung cancer: An ASTRO clinical practice guideline Pract Radiat Oncol 2020. May103158-73 - PMC - PubMed
    1. Amini A, Verma V, Simone CB, Chetty IJ, Chun SG, Donington J, Edelman MJ, Higgins KA, Kestin LL, Movsas B, Rodrigues GB, Rosenzweig KE, Rybkin II, Slotman BJ, Wolf A, Chang JY. American radium society appropriate use criteria for radiation therapy in oligometastatic or oligoprogressive non-small cell lung cancer Int J Radiat Oncol Biol Phys 2022. Feb 11122361-75 - PubMed
    1. Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, Niibe Y, Karasawa K, Hayakawa K, Takai Y, Kimura T, Takeda A, Ouchi A, Hareyama M, Kokubo M, Hara R, Itami J, Yamada K, Araki T. Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study J Thorac Oncol 2007. Jul27 Suppl 3S94-100 - PubMed
    1. Ball D, Mai GT, Vinod S, Babington S, Ruben J, Kron T, Chesson B, Herschtal A, Vanevski M, Rezo A, Elder C, Skala M, Wirth A, Wheeler G, Lim A, Shaw M, Schofield P, Irving L, Solomon B. TROG 09.02 CHISEL investigators. Stereotactic ablative radiotherapy versus standard radiotherapy in stage 1 non-small-cell lung cancer (TROG 09.02 CHISEL): a phase 3, open-label, randomised controlled trial Lancet Oncol 2019. Apr204494-503 - PubMed

LinkOut - more resources