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• W2758334036 abstract "Thoracic recurrences or metachronous malignancies after prior definitive radiotherapy (RT) pose a therapeutic challenge, as reirradiation can lead to significant toxicity given cumulative doses to surrounding organs at risk (OAR). Proton therapy (PT) has inherent characteristics that allow for delivery of highly conformal RT that in turn limits dose to OAR. The purpose of this study was to evaluate the outcomes as well as toxicity for patients who received definitive thoracic PT reirradiation. A total of 25 patients who received definitive thoracic PT reirradiation with complete clinical and dosimetric data were identified in an IRB-approved prospective patient registry. Composite plans were created using the Eclipse Treatment Planning Software (Varian Medical Systems, Palo Alto, CA), and all doses were recalculated to an equivalent dose of 200 cGy per fraction (EQD2) using an α/β of 3. Toxicity was reported using the CTCAE v4.0 and outcomes were estimated via the Kaplan-Meier method. The median time to reirradiation was 24.9 months (range, 2.7-124.1) and the median follow up time from reirradiation was 11.3 months (range, 2-27.9). All patients completed their planned course of PT with 11 (44%) receiving concurrent chemotherapy and 2 (8%) receiving sequential chemotherapy. At the time of initial diagnosis, 21 (84%) had NSCLC, 2 (8%) had SCLC, 1 (4%) had a thymic carcinoma, and 1 (4%) had oligometastatic colorectal adenocarcinoma. The median initial RT dose was 6000 cGy (range, 4500-7000) with a median dose per fraction of 200 cGy (range, 150-200). Recurrence was diagnosed histologically in 21 (84%) patients and radiographically in 4 (16%) with a median time to thoracic failure of 27.7 months (range, 3.4-203.6). The median PT reirradiation dose was 6000 CcGE (range, 4000-6250) with a median dose per fraction of 200 CcGE (range 200-1000). Composite plans revealed the following median dosimetric values: lung V20 of 23.8% (range, 4.8-49.8), heart V40 of 13.8% (range, 0.1-59.2), heart V50 of 6.3% (range, 0-52.6), maximum esophageal dose of 8692.5 cGy (range, 1881.4-11377.7), and a maximum carinal dose of 7392.7 cGy (range, 422.5-17167.6). There were 3 acute grade > 3 events, including hemoptysis (n=1) and dehydration (n=2). A total of 5 (20%) patients developed a late grade > 3 toxicity consisting of hemoptysis (n=2), non-malignant pleural effusions (n=2), and an esophageal stricture requiring dilatation (n=1). One year estimates of overall survival, distant metastasis free survival, and locoregional control were 82%, 65.5%, and 74.8%, respectively. PT reirradation is a viable treatment option for patients with thoracic recurrences or metachronous malignancies offering excellent outcomes with minimal toxicities for patients with often limited therapeutic options. Given the potential risk of acute and late toxicity, patient selection is key to maximize the benefits of therapy." @default.
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• W2758334036 date "2017-10-01" @default.
• W2758334036 modified "2023-10-16" @default.
• W2758334036 title "Proton Therapy Reirradiation for Thoracic Recurrences: Toxicity and Outcomes" @default.
• W2758334036 doi "https://doi.org/10.1016/j.ijrobp.2017.06.1676" @default.
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