Reirradiation of Thoracic Cancers with Intensity Modulated Proton Therapy

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Purpose/Objective(s)

Reirradiation of thoracic malignancies is a treatment challenge, with concerns for toxicity and inability to deliver definitive doses. Given the unique physical characteristic of the Bragg peak, intensity modulated proton therapy (IMPT) potentially can deliver a higher radiation dose to tumor while minimizing dose to normal critical tissue, compared to photon or passive scattering proton therapy. Here, we report our reirradiation experience with the use of IMPT for thoracic malignancies.

Materials/Methods

Between 2011 and 2016, 27 consecutive patients who received IMPT for reirradiation of thoracic malignancies with definitive intent were enrolled in prospectively registered clinical trials, and were retrospectively analyzed. Patients were included if they received a prior thoracic radiation course delivered with curative intent. All patients underwent 4D CT-based simulation and motion analysis and individualized tumor-motion dose-uncertainty analysis. Patients also had 4D CT resimulation during

Results

Twenty-two patients (81%) were treated for non–small cell lung cancer. The median time to reirradiation was 29.5 months. At a median follow-up for all patients of 11.2 months (25.9 months for those still alive), the median overall survival (OS) was 18.0 months, with a 1-year OS of 54%. Four patients (15%) experienced an in-field local failure (LF), with 1-year and 2-year freedom from LF rates of 78%. The 1-year freedom from local-regional relapse (LRR) and 1-year progression-free survival (PFS)

Conclusion

These data represent the first and largest series of patients treated with IMPT for definitive reirradiation of thoracic cancers. They demonstrate that IMPT can provide durable local control with minimal toxicity in patients who can have extended survival, and also suggest that higher doses may improve outcomes. IMPT appears to be a safe and effective option for the reirradiation of thoracic cancers.

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Author Disclosure: J.C. Ho: None. Q. Nguyen: None. H. Li: None. P.K. Allen: None. X. Zhang: None. X. Zhu: None. D.R. Gomez: None. S.H. Lin: Research Grant; Genentech, Peregrine Pharmaceuticals, STCube Pharmaceuticals, Hitachi, Elekta. Honoraria; AstraZeneca, ProCure, US Oncology. M.T. Gillin: None. R.U. Komaki: None. Z. Liao: None. S.M. Hahn: None. J.Y. Chang: None.

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