성균관의대 / 김나리, 노재명, 표홍렬*
Abstract
This study compared the efficacy and safety of pencil beam scanning proton therapy (PBSPT) versus intensity-modulated (photon) radiotherapy (IMRT) in patients with stage III non-small cell lung cancer (NSCLC). We retrospectively reviewed 219 patients with stage III NSCLC who received definitive concurrent chemoradiotherapy between November 2016 and December 2018. Twenty-five patients (11.4%) underwent PBSPT (23 with single-field optimization) and 194 patients (88.6%) underwent IMRT. Rates of locoregional control (LRC), overall survival, and acute/late toxicities were compared between the groups using propensity score-adjusted analyses. Patients treated with PBSPT were older (median: 67 vs. 62 years) and had worse pulmonary function at baseline (both FEV1 and DLCO) compared to those treated with IMRT. With comparable target coverage, PBSPT exhibited superior sparing of the lung, heart, and spinal cord to radiation exposure compared to IMRT. At a median follow-up of 21.7 (interquartile range: 16.8-26.8) months, the 2-year LRC rates were 72.1% and 84.1% in the IMRT and PBSPT groups, respectively (p = 0.287). The rates of grade ≥ 3 esophagitis were 8.2% and 20.0% after IMRT and PBSPT (p = 0.073), respectively, while corresponding rates of grade ≥ 2 radiation pneumonitis were 28.9% and 16.0%, respectively (p = 0.263). PBSPT appears to be an effective and safe treatment technique even for patients with poor lung function, and it does not jeopardize LRC.
Affiliation
Nalee Kim 1 , Jae Myoung Noh 1 , Woojin Lee 1 , Byoungsuk Park 1 , Hongryull Pyo 1
1 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
편집위원
국내에서 IMRT와 proton therapy를 비교한 임상연구로 proton therapy 군에서 Gr 3 skin dermatitis가 유의하게 증가하고 Gr 3 esophagitis는 빈도가 증가하며, 이에 반해 Gr 3 radiation pneumonitis는 없었다는 것을 참고하여 proton Tx가 도움이 될 수 있는 환자군을 결정하는데 도움이 될 것으로 생각됩니다.
2021-09-02 11:20:34