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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 cumulative incidence of radiation pneumonitis. The cumulative incidence was 19.8  %
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Fig2: The cumulative incidence of radiation pneumonitis. The cumulative incidence was 19.8  %

Mentions: The cumulative incidence of pneumonitis was 19.8 % (95 % confidence interval [CI]: 0–40.0 %) (Fig. 2), including one case of grade 5 pneumonitis (Table 2). Two cases (one was grade 2 pneumonitis, and another one was grade three pneumonitis) of pneumonitis were occurred within 4 months, and one case occurred within 7 months. A patient who developed grade 5 pneumonitis underwent PBT for squamous cell carcinoma of the left lower lobe. The tumor was inoperable due to poor respiratory function and IPF. The patient received 80 Gy (RBE) in 25 fractions. Three months after the first PBT treatment, the patient received 59.4 Gy (RBE) in nine fractions for a lung tumor of the right upper lobe, adjacent to the pleura. Three months after the second treatment, the patient experienced dyspnea due to radiation pneumonitis. The patient was treated with steroids and the dyspnea was relieved; however, the patient died due to acute respiratory failure 1 month later. There were no statistically significant differences with regard to the dosimetric factors in relation to the lung and the occurrence of grade 3–5 pneumonitis (Table 3).Fig. 2


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 cumulative incidence of radiation pneumonitis. The cumulative incidence was 19.8  %
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: The cumulative incidence of radiation pneumonitis. The cumulative incidence was 19.8  %
Mentions: The cumulative incidence of pneumonitis was 19.8 % (95 % confidence interval [CI]: 0–40.0 %) (Fig. 2), including one case of grade 5 pneumonitis (Table 2). Two cases (one was grade 2 pneumonitis, and another one was grade three pneumonitis) of pneumonitis were occurred within 4 months, and one case occurred within 7 months. A patient who developed grade 5 pneumonitis underwent PBT for squamous cell carcinoma of the left lower lobe. The tumor was inoperable due to poor respiratory function and IPF. The patient received 80 Gy (RBE) in 25 fractions. Three months after the first PBT treatment, the patient received 59.4 Gy (RBE) in nine fractions for a lung tumor of the right upper lobe, adjacent to the pleura. Three months after the second treatment, the patient experienced dyspnea due to radiation pneumonitis. The patient was treated with steroids and the dyspnea was relieved; however, the patient died due to acute respiratory failure 1 month later. There were no statistically significant differences with regard to the dosimetric factors in relation to the lung and the occurrence of grade 3–5 pneumonitis (Table 3).Fig. 2

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