Clinical Outcomes Following Proton and Photon Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Stereotactic Body Radiation Therapy
2.3. Assessments
2.4. Statistical Analysis
3. Results
3.1. Patient and Treatment Characteristics
3.2. Survivals
3.3. Toxicity
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Entire Cohort (N = 202) | Matched Cohort (N = 74) | ||||||
---|---|---|---|---|---|---|---|
Overall (n = 202) | Photon SBRT (n = 168) | Proton SBRT (n = 34) | p value | Photon SBRT (n = 46) | Proton SBRT (n = 28) | p value | |
Age (years, median, IQR) | 75 (70–79) | 76 (70–79) | 72.5 (68–76) | 0.288 | 75 (70–78) | 73 (68–76) | 0.411 |
Sex | 0.963 | 0.667 | |||||
Male | 161 (79.7%) | 134 (79.8%) | 27 (79.4%) | 38 (82.6%) | 22 (78.6%) | ||
Female | 41 (20.3%) | 34 (20.2%) | 7 (20.6%) | 8 (17.4%) | 6 (21.4%) | ||
ECOG PS | 0.151 | 0.113 | |||||
0–1 | 167 (82.7%) | 136 (81.0%) | 31 (91.2%) | 35 (76.1%) | 26 (92.9%) | ||
2- | 35 (17.3%) | 32 (19.0%) | 3 (8.8%) | 11 (23.9%) | 2 (7.1%) | ||
Pathology | 0.241 | 0.589 | |||||
Adenocarcinoma | 77 (38.1%) | 66 (39.3%) | 11 (32.4%) | 16 (34.8%) | 10 (35.7%) | ||
Squamous cell carcinoma | 47 (23.3%) | 38 (22.6%) | 9 (26.5%) | 12 (26.1%) | 8 (28.6%) | ||
Other | 13 (6.4%) | 13 (7.7%) | 0 (0.0%) | 3 (6.5%) | 0 (0.0%) | ||
Unproven | 65 (32.2%) | 51 (30.4%) | 14 (41.2%) | 15 (32.6%) | 10 (35.7%) | ||
Location | 0.176 | 0.479 | |||||
LLL | 34 (16.8%) | 25 (14.9%) | 9 (26.5%) | 5 (10.9%) | 7 (25.0%) | ||
LUL | 55 (27.2%) | 48 (28.6%) | 7 (20.6%) | 12 (26.1%) | 6 (21.4%) | ||
RLL | 41 (20.3%) | 31 (18.5%) | 10 (29.4%) | 11 (23.9%) | 8 (28.6%) | ||
RML | 7 (3.5%) | 6 (3.6%) | 1 (2.9%) | 3 (6.5%) | 1 (3.6%) | ||
RUL | 65 (32.2%) | 58 (34.5%) | 7 (20.6%) | 15 (32.6%) | 6 (21.4%) | ||
Tumor size (mm, mean ± SD) | 21.77 ± 8.52 | 21.62 ± 8.22 | 22.50 ± 10.00 | 0.584 | 22.00 ± 9.60 | 23.32 ± 9.96 | 0.573 |
T stage | 0.178 | 0.667 | |||||
T1 | 170 (84.2%) | 144 (85.7%) | 26 (76.5%) | 38 (82.6%) | 22 (78.6%) | ||
T2 | 32 (15.8%) | 24 (14.3%) | 8 (23.5%) | 8 (17.4%) | 6 (21.4%) | ||
COPD | 85 (42.1%) | 61 (36.3%) | 24 (70.6%) | <0.001 | 25 (54.3%) | 18 (64.3%) | 0.401 |
COPD GOLD grade | 0.001 | 0.645 | |||||
Grade 1 | 22 (10.8%) | 18 (10.7%) | 4 (11.8%) | 6 (13.0%) | 3 (10.7%) | ||
Grade 2 | 46 (22.7%) | 33 (19.6%) | 13 (38.2%) | 13 (28.3%) | 12 (42.9%) | ||
Grade 3 | 16 (7.9%) | 9 (5.4%) | 7 (20.6%) | 6 (13.0%) | 3 (10.7%) | ||
Grade 4 | 1 (0.5%) | 1 (0.6%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
ILD | 25 (12.4%) | 18 (10.7%) | 7 (20.6%) | 0.149 | 9 (19.6%) | 6 (21.4%) | 0.847 |
ILD GAP stage | 0.065 | 0.845 | |||||
Stage 1 | 6 (3.0%) | 6 (3.6%) | 0 (0.0%) | 1 (2.2%) | 0 (0.0%) | ||
Stage 2 | 17 (8.4%) | 11 (6.5%) | 6 (17.7%) | 7 (15.2%) | 5 (17.9%) | ||
Stage 3 | 2 (1.0%) | 1 (0.6%) | 1 (2.9%) | 1 (2.2%) | 1 (3.6%) | ||
Baseline FEV1 (% predicted, mean ± SD) | 77.85 ± 24.74 | 80.19 ± 25.24 | 67.38 ± 19.44 | 0.006 | 71.46 ± 22.71 | 71.25 ± 16.45 | 0.967 |
Baseline DLCO (% predicted, mean ± SD) | 68.98 ± 22.82 | 72.42 ± 21.87 | 54.52 ± 21.29 | <0.001 | 60.28 ± 17.51 | 57.68 ± 21.40 | 0.571 |
Operability | <0.001 | 0.001 | |||||
Operable | 47 (23.3%) | 47 (28.0%) | 0 (0.0%) | 13 (28.3%) | 0 (0.0%) | ||
Inoperable | 155 (76.7%) | 121 (72.0%) | 34 (100.0%) | 33 (71.7%) | 28 (100.0%) | ||
SBRT technique | <0.001 | <0.001 | |||||
3D-CRT | 130 (64.4%) | 130 (77.4%) | 0 (0.0%) | 29 (63.0%) | 0 (0.0%) | ||
IMRT | 38 (18.8%) | 38 (22.6%) | 0 (0.0%) | 17 (37.0%) | 0 (0.0%) | ||
Passive scattering | 4 (2.0%) | 0 (0.0%) | 4 (11.8%) | 0 (0.0%) | 4 (14.3%) | ||
IMPT | 30 (14.8%) | 0 (0.0%) | 30 (88.2%) | 0 (0.0%) | 24 (85.7%) | ||
Respiratory motion control | <0.001 | <0.001 | |||||
Free breathing | 187 (92.6%) | 167 (99.4%) | 20 (58.8%) | 46 (100.0%) | 16 (57.1%) | ||
Gating | 1 (0.5%) | 0 (0.0%) | 1 (2.9%) | 0 (0.0%) | 1 (3.6%) | ||
DIBH | 14 (6.9%) | 1 (0.6%) | 13 (38.2%) | 0 (0.0%) | 11 (39.3%) | ||
Dosimetric parameters | |||||||
ITV (cc, mean ± SD) | 14.44 ± 18.73 | 13.39 ± 15.07 | 19.44 ± 30.55 | 0.274 | 12.48 ± 13.63 | 19.68 ± 32.38 | 0.189 |
PTV (cc, mean ± SD) | 38.57 ± 34.74 | 36.00 ± 29.07 | 51.28 ± 53.62 | 0.115 | 34.38 ± 27.77 | 52.61 ± 55.59 | 0.064 |
Lung V40Gy (%, mean ± SD) | 4.07 ± 2.66 | 4.06 ± 2.72 | 4.12 ± 2.38 | 0.907 | 4.16 ± 3.68 | 4.49 ± 2.40 | 0.674 |
Lung V20Gy (%, mean ± SD) | 8.74 ± 4.33 | 8.90 ± 4.45 | 7.93 ± 3.61 | 0.233 | 9.28 ± 5.51 | 8.51 ± 3.45 | 0.513 |
Lung V10Gy (%, mean ± SD) | 13.78 ± 5.52 | 14.28 ± 5.52 | 11.33 ± 4.90 | 0.004 | 14.72 ± 6.09 | 12.07 ± 4.68 | 0.053 |
Lung V5Gy (%, mean ± SD) | 20.40 ± 7.90 | 21.69 ± 7.61 | 14.04 ± 6.09 | <0.001 | 22.02 ± 7.79 | 14.90 ± 5.86 | <0.001 |
Entire Cohort (N = 202) | Matched Cohort (N = 74) | |||||||
---|---|---|---|---|---|---|---|---|
Overall (n = 202) | Photon SBRT (n = 168) | Proton SBRT (n = 34) | p value | Photon SBRT (n = 46) | Proton SBRT (n = 28) | p value | ||
LC | 2-year | 92.7% | 92.8% | 92.8% | 0.602 | 94.9% | 91.3% | 0.472 |
5-year | 90.1% | 90.8% | 83.6% | 89.6% | 81.1% | |||
PFS | 2-year | 72.8% | 74.4% | 65.0% | 0.370 | 67.7% | 61.9% | 0.508 |
5-year | 60.7% | 61.6% | 57.8% | 62.9% | 55.0% | |||
OS | 2-year | 81.5% | 83.3% | 73.1% | 0.475 | 81.3% | 74.5% | 0.535 |
5-year | 50.8% | 51.7% | 51.9% | 43.4% | 74.5% | |||
CSS | 2-year | 90.1% | 91.5% | 83.5% | 0.618 | 90.4% | 80.4% | 0.946 |
5-year | 69.2% | 70.3% | 62.6% | 60.5% | 80.4% |
Entire Cohort (N = 202) | Matched Cohort (N = 74) | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Photon SBRT (n = 168) | Proton SBRT (n = 34) | p value | Photon SBRT (n = 46) | Proton SBRT (n = 28) | p value | |||||||||
G2 | G3 | G4 | G2 | G3 | G4 | G2 | G3 | G4 | G2 | G3 | G4 | |||
Radiation pneumonitis | 13 (7.7%) | 20 (11.9%) | 0 (0.0%) | 3 (8.8%) | 6 (17.6%) | 0 (0.0%) | 0.371 * | 3 (6.5%) | 11 (23.9%) | 0 (0.0%) | 3 (10.7%) | 3 (10.7%) | 0 (0.0%) | 0.398 * |
Musculoskeletal | 17 (10.1%) | 6 (3.6%) | 0 (0.0%) | 2 (5.9%) | 0 (0.0%) | 0 (0.0%) | 0.264 ** | 6 (13.0%) | 1 (2.2%) | 0 (0.0%) | 2 (7.1%) | 0 (0.0%) | 0 (0.0%) | 0.285 ** |
Skin | 3 (1.8%) | 3 (1.8%) | 1 (0.6%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0.604 ** | 2 (4.3%) | 1 (2.2%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0.468 ** |
Univariable | Multivariable | |||
---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-value | |
Sex (Male) | 7.606 (1.002–57.709) | 0.054 | ||
Age (>70) | 1.400 (0.498–3.934) | 0.523 | ||
ECOG PS (2 or higher) | 3.054 (1.231–7.580) | 0.016 | 3.162 (1.215–8.226) | 0.018 |
Smoking History (Yes) | 2.349 (0.669–8.252) | 0.183 | ||
COPD (Yes) | 1.444 (0.633–3.297) | 0.383 | ||
ILD (Yes) | 2.479 (0.886–6.937) | 0.084 | ||
T stage (T2) | 1.731 (0.635–4.718) | 0.284 | ||
Operability (Inoperable) | 8.846 (1.165–67.144) | 0.035 | 7.204 (0.929–55.863) | 0.059 |
Baseline FEV1 (<40%) | 3.818 (1.062–13.731) | 0.040 | ||
Baseline DLCO (<40%) | 4.980 (1.636–15.162) | 0.005 | 3.995 (1.259–12.675) | 0.019 |
Respiratory motion control (No) | 0.611 (0.162–2.310) | 0.468 | ||
Treatment modality (Photon) | 0.631 (0.233–1.710) | 0.365 |
Article | Patients | Stage | Dose | Follow-up | LC | OS | Toxicity |
---|---|---|---|---|---|---|---|
Hoyer et al. [18] | 40 | Stage I | 45 Gy in 3 fractions | 29 months | 2-year, 85% | 2-year, 47% | Grade ≥ 2, 48% |
Fakiris et al. [19] | 70 | T1-T2 | 60–66 Gy in 3 fractions | 50 months | 3-year, 88.1% | 3-year, 42.7% | Grade ≥ 3, 15.7% |
Baumann et al. [20] | 57 | T1-T2 | 45 Gy in 3 fractions | 35 months | 3-year, 92% | 3-year, 60% | Grade ≥ 3, 28% |
Timmerman et al. [21] | 55 | T1-T2 | 54 Gy in 3 fractions | 34 months | 3-year, 91% | 3-year, 56% | Grade ≥ 3, 16% |
Timmerman et al. [22] | 33 | T1-T2 | 54 Gy in 3 fractions | 48.1 months | 4-year, 96% | 4-year, 57% | Grade ≥ 3, 8% |
Nagata et al. [23] | 100 (inoperable) | T1 | 48 Gy in 4 fractions | 47 months | 3-year, 87.3% | 3-year, 59.9% | Grade ≥ 3, 12.5% |
64 (operable) | T1 | 48 Gy in 4 fractions | 67 months | 3-year, 85.4% | 3-year, 76.5% | Grade ≥ 3, 6.2% | |
Videtic et al. [24] | 39 | T1-T2 | 34 Gy in 1 fraction | 3.5 years | 5-year, 89.4% | 5-year, 29.6% | Grade ≥ 3, 2.6% |
45 | T1-T2 | 48 Gy in 4 fractions | 4.0 years | 5-year, 93.2% | 5-year, 41.1% | Grade ≥ 3, 11.1% | |
Current study | 168 (Photon) | T1-T2 | 60 Gy in 4 fractions | 2.7 years | 5-year, 90.8% | 5-year. 51.7% | Grade ≥ 3, 16.7% |
34 (Proton) | T1-T2 | 60 Gy in 4 fractions | 2.2 years | 5-year, 83.6% | 5-year, 51.9% | Grade ≥ 3, 17.6% |
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Bae, B.K.; Yang, K.; Noh, J.M.; Pyo, H.; Ahn, Y.C. Clinical Outcomes Following Proton and Photon Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer. Cancers 2022, 14, 4152. https://doi.org/10.3390/cancers14174152
Bae BK, Yang K, Noh JM, Pyo H, Ahn YC. Clinical Outcomes Following Proton and Photon Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer. Cancers. 2022; 14(17):4152. https://doi.org/10.3390/cancers14174152
Chicago/Turabian StyleBae, Bong Kyung, Kyungmi Yang, Jae Myung Noh, Hongryull Pyo, and Yong Chan Ahn. 2022. "Clinical Outcomes Following Proton and Photon Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer" Cancers 14, no. 17: 4152. https://doi.org/10.3390/cancers14174152
APA StyleBae, B. K., Yang, K., Noh, J. M., Pyo, H., & Ahn, Y. C. (2022). Clinical Outcomes Following Proton and Photon Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer. Cancers, 14(17), 4152. https://doi.org/10.3390/cancers14174152