Toxicity and Survival After Intensity-Modulated Proton Therapy Versus Passive Scattering Proton Therapy for NSCLC

Gjyshi, Olsi; Xu, Ting; Elhammali, Adnan; Boyce-Fappiano, David; Chun, Stephen G.; Gandhi, Saumil; Lee, Percy; Chen, Aileen B.; Lin, Steven H.; Chang, Joe Y.; Tsao, Anne S.; Zhu, Xiaorong Ronald; Zhang, Xiaodong; Heymach, John V.; Fossella, Frank V.; Lu, Charles; Nguyen, Quynh Nhu; Liao, Zhongxing

doi:10.1016/j.jtho.2020.10.013

Cited by 27 publications

(18 citation statements)

References 20 publications

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“…22,23 Of note, a recent comparison of toxicity profiles and survival after IMPT versus PSPT for NSCLC suggested that IMPT lowers radiation doses to the lung, heart, and esophagus with concomitant lower cardiopulmonary toxicities (grade !3). 24 These results confirm our conjecture that with technological improvements in dose delivery and distribution, normal tissue toxicities could be significantly reduced. Further improvements in the reduction of AEs in the treatment of lung cancers may also be achieved with unform active scanning to overcome some of the challenges discussed herein.…”

Section: Pspt Versus Imrt For Locally Advanced Nsclc (Nct00915005)supporting

confidence: 83%

Normal Tissue Injury Induced by Photon and Proton Therapies: Gaps and Opportunities

Prasanna

Rawojć

Guha

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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Despite technological advances in radiation therapy (RT) and cancer treatment, patients still experience adverse effects. Proton therapy (PT) has emerged as a valuable RT modality that can improve treatment outcomes. Normal tissue injury is an important determinant of the outcome; therefore, for this review, we analyzed 2 databases: (1) clinical trials registered with ClinicalTrials.gov and (2) the literature on PT in PubMed, which shows a steady increase in the number of publications. Most studies in PT registered with ClinicalTrials.gov with results available are nonrandomized early phase studies with a relatively small number of patients enrolled. From the larger database of nonrandomized trials, we listed adverse events in specific organs/sites among patients with cancer who are treated with photons and protons to identify critical issues. The present data demonstrate dosimetric advantages of PT with favorable toxicity profiles and form the basis for comparative randomized prospective trials. A comparative analysis of 3 recently completed randomized trials for normal tissue toxicities suggests that for early stage non-small cell lung cancer, no meaningful comparison could be made between stereotactic body RT and stereotactic body PT due to low accrual ( NCT01511081 ). In addition, for locally advanced non-small cell lung cancer, a comparison of intensity modulated RTwith passive scattering PT (now largely replaced by spot-scanned intensity modulated PT), PT did not provide any benefit in normal tissue toxicity or locoregional failure over photon therapy. Finally, for locally advanced esophageal cancer, proton beam therapy provided a lower total toxicity burden but did not improve progression-free survival and quality of life ( NCT01512589 ). The purpose of this review is to inform the limitations of current trials looking at protons and photons, considering that advances in technology, physics, and biology are a continuum, and to advocate for future trials geared toward accurate precision RT that need to be viewed as an iterative process in a defined path toward delivering optimal radiation treatment. A foundational understanding of the radiobiologic differences between protons and photons in tumor and normal tissue responses is fundamental to, and necessary for, determining the suitability of a given type of biologically optimized RT to a patient or cohort.

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Section: Pspt Versus Imrt For Locally Advanced Nsclc (Nct00915005)supporting

confidence: 83%

Normal Tissue Injury Induced by Photon and Proton Therapies: Gaps and Opportunities

Prasanna

Rawojć

Guha

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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“…Although phase II clinical trials have been promising [8][9][10], PT showed no advantage over IMRT in a randomized trial by Liao and colleagues [11,12]. These early clinical trials have mainly applied passive scattering PT, but state-of-the-art PT uses pencil beam scanning (PBS), allowing more conformal dose distributions with lower doses to critical organs [3,13].…”

Section: Introductionmentioning

confidence: 99%

Substantial Sparing of Organs at Risk with Modern Proton Therapy in Lung Cancer, but Altered Breathing Patterns Can Jeopardize Target Coverage

Boer

Fjellanger

Sandvik

et al. 2022

Cancers

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Enhancing treatment of locally advanced non-small cell lung cancer (LA-NSCLC) by using pencil beam scanning proton therapy (PBS-PT) is attractive, but little knowledge exists on the effects of uncertainties occurring between the planning (Plan) and the start of treatment (Start). In this prospective simulation study, we investigated the clinical potential for PBS-PT under the influence of such uncertainties. Imaging with 4DCT at Plan and Start was carried out for 15 patients that received state-of-the-art intensity-modulated radiotherapy (IMRT). Three PBS-PT plans were created per patient: 3D robust single-field uniform dose (SFUD), 3D robust intensity-modulated proton therapy (IMPT), and 4D robust IMPT (4DIMPT). These were exposed to setup and range uncertainties and breathing motion at Plan, and changes in breathing motion and anatomy at Start. Target coverage and dose-volume parameters relevant for toxicity were compared. The organ at risk sparing at Plan was greatest with IMPT, followed by 4DIMPT, SFUD and IMRT, and persisted at Start. All plans met the preset criteria for target robustness at Plan. At Start, three patients had a lack of CTV coverage with PBS-PT. In conclusion, the clinical potential for heart and lung toxicity reduction with PBS-PT was substantial and persistent. Altered breathing patterns between Plan and Start jeopardized target coverage for all PBS-PT techniques.

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“…Given that heart doses and their association with cardiac morbidity and mortality is now a recognised toxicity from lung radiotherapy [48], protons may have a role in reducing this, especially with more modern proton planning techniques, such as intensity modulated proton treatment (IMPT). In one non-randomised comparative non-small cell lung cancer study, IMPT patients had significantly lower lung, oesophageal and heart doses compared with passive scattering proton therapy, and significantly lower cardiac and lung toxicities [49]. The use of MRI-guidance could overcome some of the image-guidance challenges in treating lung cancer patients with proton therapy, enabling the predicted benefits in local control and toxicity to be realised.…”

Section: Mri-guided Proton Therapy -Advantages For Assessing Inter-fr...mentioning

confidence: 99%

Magnetic resonance imaging (MRI) guided proton therapy: A review of the clinical challenges, potential benefits and pathway to implementation

Pham

Whelan

Oborn

et al. 2022

Radiotherapy and Oncology

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Toxicity and Survival After Intensity-Modulated Proton Therapy Versus Passive Scattering Proton Therapy for NSCLC

Cited by 27 publications

References 20 publications

Normal Tissue Injury Induced by Photon and Proton Therapies: Gaps and Opportunities

Normal Tissue Injury Induced by Photon and Proton Therapies: Gaps and Opportunities

Substantial Sparing of Organs at Risk with Modern Proton Therapy in Lung Cancer, but Altered Breathing Patterns Can Jeopardize Target Coverage

Magnetic resonance imaging (MRI) guided proton therapy: A review of the clinical challenges, potential benefits and pathway to implementation

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