Multi-Institutional Prospective Study of Reirradiation with Proton Beam Radiotherapy for Locoregionally Recurrent Non–Small Cell Lung Cancer

Abstract

In this prospective study, PRT for recurrent NSCLC is feasible but can be associated with significant toxicity. Providers should remain cautious in reirradiating NSCLC, paying close consideration to tumor volume, location, and relevant dosimetric parameters. Further research is needed for optimal patient selection to improve overall outcomes.

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

“…Proton beam therapy for reRT has been investigated at other disease sites including head and neck, 38,39 central nervous system, 40,41 lung, 42,43 gynecological, 44 and gastrointestinal malignancies. [45][46][47] A recent systematic review found that reRT with PBT is safe and effective.…”

Innovations in the treatment of non-small cell lung cancer

“…The authors concluded that the simple tracking method was valuable for improving GTV coverage. The practicalities and limitations of tracking and gating techniques in IMPT have also been reported by the group at Paul Scherrer Institute 41,42 Another key aspect is plan robustness, meaning the susceptibility of the nominal treatment plan due to uncertainties (e.g., setup uncertainties) or motion. Some treatment planning systems already allow the evaluation of plan robustness.…”

“…In a phase II clinical trial with sorafenib monotherapy for 57 pre-treated Stage IIIB-IV NSCLC patients with a KRAS mutation, a partial response occurred more frequently in the five patients using metformin during treatment compared with the non-users (p=0.01) 41 . Groenendijk et al 42 recently published a post hoc analysis on that study, reporting that six weeks after treatment with sorafenib, all patients using metformin had either a partial response or stable disease, while 27 of the patients not using metformin had progressive disease (p=0.01). Taking these findings from bed to benchside, the authors treated NSCLC cell lines and mouse NSCLC-xenograft tumours with sorafenib and metformin (monotherapy or in combination) and found an anti-proliferative effect in the NSCLC cell lines and a lower mean tumour volume in the xenografts treated with the drug combination compared to sorafenib monotherapy (p=0.046).…”

“…When looking into the risk factors for RR after surgery for early stage NSCLC, there are two types of studies. Most studies have investigated predictive factors for ONM in clinical stage I NSCLC through examination of the resected specimens of the tumour and the lymph nodes 11,[38][39][40][41][42][43] . Identified risk factors for ONM include larger tumour size, solid consistency on high-resolution CT, adenocarcinoma, higher SUV max , increased carcinoembryonic antigen level, visceral pleural invasion (VPI), and poor pathological differentiation.…”

“…Meanwhile, the first prospective clinical results of re-irradiated non-small cell lung cancers have been published [41][42][43] . Passive scatter proton therapy was the predominant form of proton beam delivery in most series.…”