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• W2024454028 abstract "Proton beam has a distinctive depth–dose curve called Bragg–peak that enables us to deliver higher doses to the tumor without increasing doses to the surrounding normal tissues. We retrospectively evaluated the safety and efficacy of proton therapy in patients with stage I NSCLC. Between December 1999 and October 2003, 36 patients with stage I NSCLC were treated by proton therapy in our institution. The indication for proton therapy were 1) clinical stage I NSCLC, 2) PaO2 ≥ 60 torr, 3) medically inoperable, or refusal of surgery, 4) performance status 0–2, 5) written informed consent. The clinical target volume (CTV) was defined as the gross tumor volume plus 8 mm margin in all directions, and the planning target volume was defined as the CTV plus 5 mm for set–up margin and 5 mm for respiratory motion in all directions. Daily verification of patient positioning was performed using digital radiography and treatment was performed with respiratory gating. A total dose of 70–94 GyE was delivered in 20 fractions over 4 to 5 weeks with 2 or 4 portals of 150 or 190 MeV proton beam. The relative biological effectiveness of our proton beam was defined as 1.1. Kaplan–Meier method was used to assess overall survival and local control rates. CTC version 2.0 was used to assess toxicity. Patients characteristics were as follows; median age 75 years (range, 63 to 87 years), male/female: 29/7, Stage IA/IB: 17/19, squamous/ adenocarcinoma/ others: 15/15/6, medically inoperable/refusal of surgery: 22/14. The numbers of patients who received 70/80/88/94 GyE were 3/16/16/1, respectively. Ten patients who were enrolled in our dose escalation study were included in this analysis. The median follow-up period was 18.0 months (range, 3.3 to 47.5 months). The response rate was 86.1% (95% confidence interval, 70.5 to 95.3%), and 1– and 2– year local control rates were 96.7% and 92.6%, respectively. There were no grade 2 or greater acute toxicities observed. Grade 2 and 3 late pulmonary toxicities were observed in 3 and 3 patients, respectively. The 1– and 2–year overall survivals were 93% and 81%, respectively. In patients who refused surgery, the 2–year overall survival was 87.5%. Local progressions were observed in 2 stage IB patients. Eight stage IB patients developed regional lymph node and/or distant metastases. Five of 6 patients who suffered grade ≥ 2 late pulmonary toxicities had stage IB disease. Proton therapy is a promising treatment modality for stage I NSCLC. The local control and overall survival rates seemed comparable to those of surgery. The acute toxicity of proton therapy was acceptable, but substantial late pulmonary toxicity was observed in stage IB patients. To evaluate the efficacy of proton therapy, a prospective multi–institutional phase II study is mandatory" @default.
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• W2024454028 date "2004-09-01" @default.
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• W2024454028 title "Proton therapy for stage I non-small cell lung cancer (NSCLC)" @default.
• W2024454028 doi "https://doi.org/10.1016/j.ijrobp.2004.07.072" @default.
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