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• W2137332022 abstract "Purpose/Objective(s)To assess late pulmonary toxicity, including pneumonitis, pulmonary fibrosis, pleural effusion, and bronchial stenosis, in patients with non-small cell lung cancer (NSCLC) treated with conventionally fractionated proton therapy (PT).Materials/MethodsFrom 2006 to 2012, 47 patients with NSCLC were curatively treated with conventionally fractionated PT; 41 patients were treated for primary disease and 6 patients were treated for recurrent disease. Most patients had locally advanced disease; the stage distribution was as follows: stage I, 5; stage II, 7; stage III, 33, and stage IV, 2. Most patients (N = 40) had favorable baseline performance status (PS) 0-1 and 7 patients had baseline PS of 2. The median PT dose was 74 CGE with 14 patients treated to a total dose >74 CGE. In addition, 39 patients received chemotherapy. Patients were followed every 3 months after PT with either CT or PET-CT. Follow-up images were assessed by LM and re-evaluated by a body radiologist for radiographic toxicity. Medical records were also reviewed for clinical symptomatic toxicities. Toxicity was graded per Common Terminology Criteria for Adverse Events version 4.0, and censored at the time of local failure. Pneumonitis was recorded only within the first 6 months after PT.ResultsThe median follow-up time was 1.4 years for all patients and 2.3 years for living patients. For all patients, the 2-year overall survival (OS) rate was 41% and for stage III/IV patients with PS 0-1 it was 49%. Eight patients (19%) experienced grade 2+ toxicity, including grade 2 pneumonitis (N = 2), grade 2 fibrosis (N = 1), grade 3 fibrosis (N = 1), grade 2 pleural effusion (N = 1), grade 2 bronchial stenosis (N = 2), and grade 5 bronchial stenosis (N = 1). The median time to occurrence of grade 2+ pulmonary toxicity was 0.6 years. The patient with grade 5 bronchial stenosis had T1 N2 disease with a right lower-lobe primary and developed bronchial stenosis 12 months after PT, which led to pneumonia and death. Most patients (N = 30) developed grade 1 fibrosis with a median time to occurrence of 0.41 years, 14 patients had grade 1 pleural effusion with a median time to occurrence of 0.41 years, and 3 patients had grade 1 bronchial stenosis with a median time to occurrence of 0.91 years. All 6 bronchial stenosis occurred in patients with right-sided tumors, which was found to be a significant predictor on univariate analysis (p = 0.0478). Right-sided primary tumor location also impacted grade 2+ pulmonary toxicity on univariate analysis (p = 0.0207).ConclusionsTwo-year OS in stage III patients is promising. Right-sided location of primary lung tumors predicts for grade 2+ pulmonary toxicity following PT. Assessing pulmonary toxicities is complicated and subjective. Longer follow-up in a larger cohort is needed to confirm these results. Purpose/Objective(s)To assess late pulmonary toxicity, including pneumonitis, pulmonary fibrosis, pleural effusion, and bronchial stenosis, in patients with non-small cell lung cancer (NSCLC) treated with conventionally fractionated proton therapy (PT). To assess late pulmonary toxicity, including pneumonitis, pulmonary fibrosis, pleural effusion, and bronchial stenosis, in patients with non-small cell lung cancer (NSCLC) treated with conventionally fractionated proton therapy (PT). Materials/MethodsFrom 2006 to 2012, 47 patients with NSCLC were curatively treated with conventionally fractionated PT; 41 patients were treated for primary disease and 6 patients were treated for recurrent disease. Most patients had locally advanced disease; the stage distribution was as follows: stage I, 5; stage II, 7; stage III, 33, and stage IV, 2. Most patients (N = 40) had favorable baseline performance status (PS) 0-1 and 7 patients had baseline PS of 2. The median PT dose was 74 CGE with 14 patients treated to a total dose >74 CGE. In addition, 39 patients received chemotherapy. Patients were followed every 3 months after PT with either CT or PET-CT. Follow-up images were assessed by LM and re-evaluated by a body radiologist for radiographic toxicity. Medical records were also reviewed for clinical symptomatic toxicities. Toxicity was graded per Common Terminology Criteria for Adverse Events version 4.0, and censored at the time of local failure. Pneumonitis was recorded only within the first 6 months after PT. From 2006 to 2012, 47 patients with NSCLC were curatively treated with conventionally fractionated PT; 41 patients were treated for primary disease and 6 patients were treated for recurrent disease. Most patients had locally advanced disease; the stage distribution was as follows: stage I, 5; stage II, 7; stage III, 33, and stage IV, 2. Most patients (N = 40) had favorable baseline performance status (PS) 0-1 and 7 patients had baseline PS of 2. The median PT dose was 74 CGE with 14 patients treated to a total dose >74 CGE. In addition, 39 patients received chemotherapy. Patients were followed every 3 months after PT with either CT or PET-CT. Follow-up images were assessed by LM and re-evaluated by a body radiologist for radiographic toxicity. Medical records were also reviewed for clinical symptomatic toxicities. Toxicity was graded per Common Terminology Criteria for Adverse Events version 4.0, and censored at the time of local failure. Pneumonitis was recorded only within the first 6 months after PT. ResultsThe median follow-up time was 1.4 years for all patients and 2.3 years for living patients. For all patients, the 2-year overall survival (OS) rate was 41% and for stage III/IV patients with PS 0-1 it was 49%. Eight patients (19%) experienced grade 2+ toxicity, including grade 2 pneumonitis (N = 2), grade 2 fibrosis (N = 1), grade 3 fibrosis (N = 1), grade 2 pleural effusion (N = 1), grade 2 bronchial stenosis (N = 2), and grade 5 bronchial stenosis (N = 1). The median time to occurrence of grade 2+ pulmonary toxicity was 0.6 years. The patient with grade 5 bronchial stenosis had T1 N2 disease with a right lower-lobe primary and developed bronchial stenosis 12 months after PT, which led to pneumonia and death. Most patients (N = 30) developed grade 1 fibrosis with a median time to occurrence of 0.41 years, 14 patients had grade 1 pleural effusion with a median time to occurrence of 0.41 years, and 3 patients had grade 1 bronchial stenosis with a median time to occurrence of 0.91 years. All 6 bronchial stenosis occurred in patients with right-sided tumors, which was found to be a significant predictor on univariate analysis (p = 0.0478). Right-sided primary tumor location also impacted grade 2+ pulmonary toxicity on univariate analysis (p = 0.0207). The median follow-up time was 1.4 years for all patients and 2.3 years for living patients. For all patients, the 2-year overall survival (OS) rate was 41% and for stage III/IV patients with PS 0-1 it was 49%. Eight patients (19%) experienced grade 2+ toxicity, including grade 2 pneumonitis (N = 2), grade 2 fibrosis (N = 1), grade 3 fibrosis (N = 1), grade 2 pleural effusion (N = 1), grade 2 bronchial stenosis (N = 2), and grade 5 bronchial stenosis (N = 1). The median time to occurrence of grade 2+ pulmonary toxicity was 0.6 years. The patient with grade 5 bronchial stenosis had T1 N2 disease with a right lower-lobe primary and developed bronchial stenosis 12 months after PT, which led to pneumonia and death. Most patients (N = 30) developed grade 1 fibrosis with a median time to occurrence of 0.41 years, 14 patients had grade 1 pleural effusion with a median time to occurrence of 0.41 years, and 3 patients had grade 1 bronchial stenosis with a median time to occurrence of 0.91 years. All 6 bronchial stenosis occurred in patients with right-sided tumors, which was found to be a significant predictor on univariate analysis (p = 0.0478). Right-sided primary tumor location also impacted grade 2+ pulmonary toxicity on univariate analysis (p = 0.0207). ConclusionsTwo-year OS in stage III patients is promising. Right-sided location of primary lung tumors predicts for grade 2+ pulmonary toxicity following PT. Assessing pulmonary toxicities is complicated and subjective. Longer follow-up in a larger cohort is needed to confirm these results. Two-year OS in stage III patients is promising. Right-sided location of primary lung tumors predicts for grade 2+ pulmonary toxicity following PT. Assessing pulmonary toxicities is complicated and subjective. Longer follow-up in a larger cohort is needed to confirm these results." @default.
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• W2137332022 date "2013-10-01" @default.
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• W2137332022 title "Pulmonary Toxicity Following Proton Therapy for Patients With Non-Small Cell Lung Cancer" @default.
• W2137332022 doi "https://doi.org/10.1016/j.ijrobp.2013.06.524" @default.
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