Limits...
The clinical results of proton beam therapy in patients with idiopathic pulmonary fibrosis: a single center experience.

Ono T, Hareyama M, Nakamura T, Kimura K, Hayashi Y, Azami Y, Hirose K, Hatayama Y, Suzuki M, Wada H, Kikuchi Y, Nemoto K - Radiat Oncol (2016)

Bottom Line: The median dose of PBT was 80.0 Gy relative biological dose effectiveness (RBE) (range: 66.0-86.4 Gy [RBE]).Reduced respiratory function was observed after PBT in seven patients, including one patient with pleural dissemination; five of these patients required home oxygen therapy.This study suggests that PBT can be performed more safely in IPF patients than surgery or X-ray irradiation.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan. abc1123513@gmail.com.

ABSTRACT

Background: The purpose of this study is to retrospectively evaluate the incidence of lung toxicities after proton beam therapy (PBT) in patients with idiopathic pulmonary fibrosis (IPF).

Methods: Patients diagnosed with primary lung cancer or lung metastasis who were treated with PBT between January 2009 and May 2015 were recruited from our database retrospectively. Cases of pneumonitis (excluding infection-related pneumonitis) were evaluated using the Common Terminology Criteria for Adverse Events version 4.0, and the Fletcher-Hugh-Jones classification of respiratory status was used to evaluate pretreatment and posttreatment respiratory function.

Results: Sixteen IPF patients received PBT for lung tumors, 15 received PBT for primary lung cancer, and one patient received PBT for metastasis from lung cancer. The cohort was composed of 14 men and 2 women, with a median age of 76 years (range: 63-89 years). The median follow-up time was 12 months (range: 4-39 months). The median dose of PBT was 80.0 Gy relative biological dose effectiveness (RBE) (range: 66.0-86.4 Gy [RBE]). The cumulative incidence of pneumonitis was 19.8 % (95 % confidence interval [CI]: 0-40.0 %), including one case of grade 5 pneumonitis. Reduced respiratory function was observed after PBT in seven patients, including one patient with pleural dissemination; five of these patients required home oxygen therapy.

Conclusions: This study suggests that PBT can be performed more safely in IPF patients than surgery or X-ray irradiation. Although PBT has become a treatment choice for lung tumors of patients with IPF, the adverse events warrant serious attention.

No MeSH data available.


Related in: MedlinePlus

The dose distribution map for proton beam therapy for a lung cancer patient with idiopathic fibrosis. The region outside the outermost line received <10 % radiation
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4835903&req=5

Fig1: The dose distribution map for proton beam therapy for a lung cancer patient with idiopathic fibrosis. The region outside the outermost line received <10 % radiation

Mentions: Treatment planning for PBT was based on three-dimensional CT images that were taken at 2 mm intervals in the exhalation phase while using a respiratory gating system (Anzai Medical, Tokyo, Japan). A custom-indexed vacuum-lock bag was used to immobilize the patients. An Xio-M (CMS Japan, Tokyo, Japan; and Mitsubishi Electric) treatment planning system was used to calculate the dose distributions for PBT. The gross tumor volume (GTV) included the lung tumor. The clinical target volume (CTV) was defined as GTV plus 0.5 cm. The planning target volume (PTV) was CTV plus a 0.5 cm margin. When respiratory movement was large, the gap of base position in the exhalation phase was over 30 %, despite the use of the respiratory gating system, a 0.2–0.5 longitudinal margin was added to the PTV. Proton energy levels of 150 MeV and 210 for 2–3 fields, and a spread-out Bragg peak were tuned to the extent that was possible until the PTV was exposed to a 90 % isodose of the prescribed dose (Fig. 1). The PBT system at our institute (Proton Beam System, Mitsubishi, Tokyo, Japan) used a synchrotron, and a passive scattering method in which a proton beam passes a bar ridge filter, a range shifter, and a customized compensator before entering the patient. Treatment was administered during the exhalation phase using a respiratory gating system. A multileaf collimator, which consisted of 40 iron plates with a width of 3.75 mm, and which could be formed into an irregular shape, was used. Daily front and lateral X-ray imaging was used for positioning. The PBT schedule was 66 Gy relative biological dose effectiveness (RBE) in 10 fractions over 2 weeks for peripheral lung tumors, and 80 Gy (RBE) in 25 fractions over 5 weeks for central or centrally located lung tumors. The biologically equivalent dose of 10 for 66 Gy (RBE) and 80 Gy (RBE) was 109.56 Gy (RBE) and 105.6 Gy (RBE) respectively. Patients with lung tumors located near the large intestine or small intestine and those with severe respiratory dysfunction (such as patients who required home oxygen therapy), received 79.2–86.4 Gy (RBE) in 33–36 fractions over 7 weeks. Dose constrains were set for the esophagus (≤55 Gy [RBE]), spinal cord (≤40 Gy [RBE]), trachea/bronchus (≤55 Gy [RBE]), and heart (≤40 Gy [RBE]).Fig. 1


The clinical results of proton beam therapy in patients with idiopathic pulmonary fibrosis: a single center experience.

Ono T, Hareyama M, Nakamura T, Kimura K, Hayashi Y, Azami Y, Hirose K, Hatayama Y, Suzuki M, Wada H, Kikuchi Y, Nemoto K - Radiat Oncol (2016)

The dose distribution map for proton beam therapy for a lung cancer patient with idiopathic fibrosis. The region outside the outermost line received <10 % radiation
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835903&req=5

Fig1: The dose distribution map for proton beam therapy for a lung cancer patient with idiopathic fibrosis. The region outside the outermost line received <10 % radiation
Mentions: Treatment planning for PBT was based on three-dimensional CT images that were taken at 2 mm intervals in the exhalation phase while using a respiratory gating system (Anzai Medical, Tokyo, Japan). A custom-indexed vacuum-lock bag was used to immobilize the patients. An Xio-M (CMS Japan, Tokyo, Japan; and Mitsubishi Electric) treatment planning system was used to calculate the dose distributions for PBT. The gross tumor volume (GTV) included the lung tumor. The clinical target volume (CTV) was defined as GTV plus 0.5 cm. The planning target volume (PTV) was CTV plus a 0.5 cm margin. When respiratory movement was large, the gap of base position in the exhalation phase was over 30 %, despite the use of the respiratory gating system, a 0.2–0.5 longitudinal margin was added to the PTV. Proton energy levels of 150 MeV and 210 for 2–3 fields, and a spread-out Bragg peak were tuned to the extent that was possible until the PTV was exposed to a 90 % isodose of the prescribed dose (Fig. 1). The PBT system at our institute (Proton Beam System, Mitsubishi, Tokyo, Japan) used a synchrotron, and a passive scattering method in which a proton beam passes a bar ridge filter, a range shifter, and a customized compensator before entering the patient. Treatment was administered during the exhalation phase using a respiratory gating system. A multileaf collimator, which consisted of 40 iron plates with a width of 3.75 mm, and which could be formed into an irregular shape, was used. Daily front and lateral X-ray imaging was used for positioning. The PBT schedule was 66 Gy relative biological dose effectiveness (RBE) in 10 fractions over 2 weeks for peripheral lung tumors, and 80 Gy (RBE) in 25 fractions over 5 weeks for central or centrally located lung tumors. The biologically equivalent dose of 10 for 66 Gy (RBE) and 80 Gy (RBE) was 109.56 Gy (RBE) and 105.6 Gy (RBE) respectively. Patients with lung tumors located near the large intestine or small intestine and those with severe respiratory dysfunction (such as patients who required home oxygen therapy), received 79.2–86.4 Gy (RBE) in 33–36 fractions over 7 weeks. Dose constrains were set for the esophagus (≤55 Gy [RBE]), spinal cord (≤40 Gy [RBE]), trachea/bronchus (≤55 Gy [RBE]), and heart (≤40 Gy [RBE]).Fig. 1

Bottom Line: The median dose of PBT was 80.0 Gy relative biological dose effectiveness (RBE) (range: 66.0-86.4 Gy [RBE]).Reduced respiratory function was observed after PBT in seven patients, including one patient with pleural dissemination; five of these patients required home oxygen therapy.This study suggests that PBT can be performed more safely in IPF patients than surgery or X-ray irradiation.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan. abc1123513@gmail.com.

ABSTRACT

Background: The purpose of this study is to retrospectively evaluate the incidence of lung toxicities after proton beam therapy (PBT) in patients with idiopathic pulmonary fibrosis (IPF).

Methods: Patients diagnosed with primary lung cancer or lung metastasis who were treated with PBT between January 2009 and May 2015 were recruited from our database retrospectively. Cases of pneumonitis (excluding infection-related pneumonitis) were evaluated using the Common Terminology Criteria for Adverse Events version 4.0, and the Fletcher-Hugh-Jones classification of respiratory status was used to evaluate pretreatment and posttreatment respiratory function.

Results: Sixteen IPF patients received PBT for lung tumors, 15 received PBT for primary lung cancer, and one patient received PBT for metastasis from lung cancer. The cohort was composed of 14 men and 2 women, with a median age of 76 years (range: 63-89 years). The median follow-up time was 12 months (range: 4-39 months). The median dose of PBT was 80.0 Gy relative biological dose effectiveness (RBE) (range: 66.0-86.4 Gy [RBE]). The cumulative incidence of pneumonitis was 19.8 % (95 % confidence interval [CI]: 0-40.0 %), including one case of grade 5 pneumonitis. Reduced respiratory function was observed after PBT in seven patients, including one patient with pleural dissemination; five of these patients required home oxygen therapy.

Conclusions: This study suggests that PBT can be performed more safely in IPF patients than surgery or X-ray irradiation. Although PBT has become a treatment choice for lung tumors of patients with IPF, the adverse events warrant serious attention.

No MeSH data available.


Related in: MedlinePlus