Particle beam radiation therapy using carbon ions and protons for oligometastatic lung tumors

Abstract

BackgroundA study was undertaken to analyze the efficacy and feasibility of particle beam radiation therapy (PBRT) using carbon ions and protons for the treatment of patients with oligometastatic lung tumors.MethodsA total of 47 patients with 59 lesions who underwent PBRT for oligometastatic lung tumors between 2003 and 2011 were included in this study. Patient median age was 66 (range, 39–84) years. The primary tumor site was the colorectum in 11 patients (23.4%), lung in 10 patients (21.3%) and a variety of other sites in 26 patients (55.3%). Thirty-one patients (66%) received chemotherapy prior to PBRT. Thirty-three lesions were treated with 320-MeV carbon ions and 26 were treated with 150- or 210-Mev protons in 1–4 portals. A median total dose of 60 (range, 52.8–70.2) GyE was delivered at the isocenter in 8 (range, 4–26) fractions.ResultsThe median follow-up time was 17 months. The local control, overall survival and progression-free survival rates at 2 years were 79%, 54 and 27% respectively. PBRT-related toxicities were observed; six patients (13%) had grade 2 toxicity (including grade 2 radiation pneumonitis in 2) and six patients (13%) had grade 3 toxicity. Univariate analysis indicated that patients treated with a biologically equivalent dose of 10 (BED10) <110 GyE10, had a significantly higher local recurrence rate. Local control rates were relatively lower in the subsets of patients with the colorectum as the primary tumor site. No local progression was observed in metastases from colorectal cancer irradiated with a BED10 ≥ 110 GyE10. There was no difference in treatment results between proton and carbon ion therapy.ConclusionsPRBT is well tolerated and effective in the treatment of oligometastatic lung tumors. To further improve local control, high-dose PBRT with a BED10 ≥ 110 GyE10 may be promising. Further investigation of PBRT for lung oligometastases is warranted.

Stereotactic Radiotherapy for Pulmonary Oligometastases From Colorectal Cancer: A Systematic Review and Meta-Analysis

“…Data from 18 retrospective studies with 1920 patients were used in the meta-analysis. The patients included 619 patients with pulmonary oligometastases from colorectal cancer treated by SBRT and 1301 patients with pulmonary oligometastases from other cancers treated by SBRT (meta-analysis 1; 2 – 5 , 7 – 20 Table 1 ). The local control rate in patients with pulmonary oligometastases from colorectal cancer was significantly lower than that in patients with pulmonary oligometastases from other cancers (OR = 3.17, 95% CI: 1.98-5.08, P < .00001) with substantial heterogeneity ( P = .02, I 2 = 47%; Figure 2 ).…”

Multi-Institutional Retrospective Analysis of the Outcomes of Proton Beam Therapy for Patients With 1 to 3 Pulmonary Oligometastases From Various Primary Cancers

“…A previous Japanese single-center study reported the outcome of particle beam therapy using carbon ions and protons and showed the 2-year local control rate (LC), PFS, and OS values of 79%, 27%, and 54%, respectively, with the efficacy of PBT being equivalent to carbon ion therapy for treating pulmonary oligometasis. 9 Although there is insufficient evidence on the effectiveness of PBT for pulmonary oligometastasis, several studies on x-ray SBRT for pulmonary oligometastasis were reported. 3 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Baschangel et al, 13 in a retrospective analysis of 32 patients with 1 to 3 pulmonary oligometastases, showed that the 2-year LCs of CRC, NCRC, and all patients were 80%, 100%, and 92%, respectively.…”

“… 7 , 8 However, to the best of our knowledge, only 1 study has focused on the outcomes of PBT in patients with limited metastatic pulmonary diseases. 9 Therefore, in this study, we aimed to evaluate the efficacy and safety of PBT retrospectively for patients with 1 to 3 pulmonary oligometastases from miscellaneous primary cancers across multiple facilities in Japan.…”

Evidence for surgical resections in oligometastatic lung cancer

“…At present, the management of patients with NSCLC has been changing rapidly. Most of the surgical literature advocate resection of the primary cancer with either surgical metastasectomy with or without chemotherapy, ablation of the metastatic lesion using radiofrequency, microwave, cryotherapy with or without chemotherapy or stereotactic body radiation therapy (SBRT) with or with chemotherapy (11). With the use of immunotherapy both in the early and late phase of the disease, it has contributed a lot to the paradigm shift in lung cancer treatment.…”