Effects of proton and combined proton photon beam radiation on pulmonary function in patients with resectable but medically inoperable non-small cell lung cancer

被引:32
作者
Bonnet, RB
Bush, D
Cheek, GA
Slater, JD
Panossian, D
Franke, C
Slater, JM
机构
[1] Zentralklin Bad Berka GmbH, Klin Pneumol, Dept Pulm Med, D-99438 Bad Berka, Germany
[2] Loma Linda Univ, Div Pulm & Crit Care Med, Loma Linda, CA 92350 USA
[3] Loma Linda Univ, Dept Radiat Med, Loma Linda, CA 92350 USA
关键词
irradiation; lung cancer treatment; non-small cell lung cancer; photon; proton; radiation;
D O I
10.1378/chest.120.6.1803
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objectives: We evaluated the effects on pulmonary function of irradiating lung cancer with protons alone or protons combined with photons. Design: Prospective phase I/II study. Setting: University medical center. Patients and interventions: Ten patients with stage I-II non-small cell lung cancer (NSCLC) and FEV1 less than or equal to 1.0 L were irradiated with protons to areas of gross disease only, using 51 cobalt gray equivalents (CGE) in 10 fractions (protocol 1). Fifteen patients with stage I-IIIA NSCLC and FEV1 > 1.0 L received 5-Gy photon irradiation to the primary lung tumor and the mediastinum, plus a 28.8-CGE proton boost to the gross tumor volume (protocol 2). Measurements: Pulmonary function was evaluated prior to treatment and 1 month, 3 months, and 6 to 12 months following irradiation. Results: In patients receiving protocol 1, no significant changes in pulmonary function occurred. In patients receiving protocol 2, at 6 to 12 months, the diffusion capacity of the lung for carbon monoxide had declined from 61% of predicted to 45% of predicted (p < 0.05), total lung capacity had declined from 114% of predicted to 95% of predicted (p < 0.05), and residual volume had declined from 160% of predicted to 132% of predicted (p < 0.05). Airway resistance increased from 3.8 to 5.2 cm H2O/L/s (p < 0.05). No statistically significant changes occurred in vital capacity, FEV1, or PaO2. Conclusions: Our observations indicate that it is feasible to apply higher-than-conventional doses of radiation at a higher-than-conventional dose per fraction without excess pulmonary toxicity when conformal radiation techniques with protons are used.
引用
收藏
页码:1803 / 1810
页数:8
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