Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Oncology Group Study JCOG0403. Int J Radiat Oncol Biol Phys 93:989-96, 2015
6. Guckenberger M, Klement RJ, Allgauer M, et al: Applicability of the linearquadratic
formalism for modeling local tumor control probability in high
dose per fraction stereotactic body radiotherapy for early stage non-small
cell lung cancer. Radiother Oncol 109:13-20, 2013 7. Huang K, Dahele M, Senan
S, et al: Radiographic changes after lung stereotactic ablative radiotherapy
(SABR) - Can we distinguish recurrence from fibrosis? A systematic review
of the literature. Radiother Oncol 102:335-42, 2012 8. Peulen H, Mantel
F, Guckenberger M, et al: Validation of High-Risk Computed Tomography
Features for Detection of Local Recurrence After Stereotactic Body Radiation
Therapy for Early-Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol
Phys 96:134-41, 2016
Keywords: stereotactic body radiotherapy, non-small cell lung cancer, early
stage
SC03: ADVANCES IN RADIATION ONCOLOGY
MONDAY, DECEMBER 5, 2016 - 11:00-12:30
SC03.02 PROTON THERAPY OF LUNG CANCER
Jeffrey Bradley
Radiation Oncology, Washington University School of Medicine, St. Louis/United
States of America
This session will focus on the use of proton beam radiation therapy for
lung cancer. We will review the basic physics of proton beam therapy, why
protons are different from photon-based radiation therapy, and the potential
advantages of using proton beam therapy to treat lung cancer. We will review
the current data about the use of protons, both published and unpublished,
and provide updates about ongoing clinical trials testing proton therapy in
lung cancer patients.
Keywords: protons, radiation therapy, lung cancer, clinical trials
SC03: ADVANCES IN RADIATION ONCOLOGY
MONDAY, DECEMBER 5, 2016 - 11:00-12:30
SC03.03 CARBON-ION THERAPY OF LUNG CANCER
Yuko Nakayama
Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama/Japan
Introduction Approximately 65 particle therapy facilities are in operation
worldwide. Among them, only 10 have carbon-ion therapy (CIRT) facilities (5 in
Japan, 2 in Germany, 2 in China, and 1 in Italy), and the remainder have proton
therapy facilities. More than 137,000 patients were treated with particle
therapy worldwide from 1954 to 2014, including 15,000 in 2014, 86% of which
were treated with protons and 14% with carbon ions and other particles.
(from the Particle Therapy Co-Operative Group: http://www.ptcog.ch/). The
National Institute of Radiological Sciences (NIRS) Chiba, Japan, has been
treating cancer with high-energy carbon ions since 1994. Most of the patients
who have been cured of cancer worldwide with carbon ions were treated
at NIRS (1). From NIRS’s data, the efficacy of CIRT for non-small cell lung
cancer (NSCLC) has been suggested. Here those results are reviewed, and the
issue of this modern technology is discussed. Characteristics of carbon-ion
therapy CIRT has better dose distribution to tumor tissue, while minimizing
surrounding normal tissue dose, compared with photon radiotherapy.
Moreover, carbon ions have potential advantages over protons. They provide
a better physical dose distribution due to lessened lateral scattering. Further,
their higher relative biological effectiveness and lower oxygen enhancement
ratio are desirable features for targeting radioresistant, hypoxic tumors.
The difference between densely ionizing nuclei and sparsely ionising x-rays
and protons offers further potential radiobiological advantages, such as
reduced repair capacity, decreased cell-cycle dependence, and possibly
stronger immunological responses. Carbon-ion therapy of early non-small
cell lung cancer Surgical resection with lobectomy has been the standard
treatment of choice for early-stage NSCLC. In a 2004 study of a Japanese lung
cancer registry comprising 11,663 surgical cases, overall survival (OS) rates
at 5 years for stages IA and IB disease are 82.0% and 66.8%, respectively
(2). Radiotherapy is an option for patients who are not eligible for surgery
or refuse it. Recently, hypofractionated radiotherapy is regarded as an
alternative to surgery for localized NSCLC, using x-ray stereotactic body
radiotherapy (SBRT) or particle therapy using protons or carbon-ions. With
regard to CIRT, for peripheral stage I NSCLC, the number of fractions was
reduced in different trials from 18 to 9, then 4, and finally to a single fraction
at NIRS (Table 1). The results with CIRT in stage IA NSCLC are similar to the best
SBRT results reported worldwide. For stage IB disease, CIRT results appear
superior to those reported for photon SBRT in terms of local control and lung
toxicity. Despite high local control, disease-specific survival is much lower in
stage IB than in stage IA because distant metastatic recurrences are common.
A combination of CIRT with systemic therapy is therefore essential to improve
survival. CIRT demonstrates a better dose distribution than both SBRT and
proton therapy in most cases of early-stage lung cancer. Therefore, CIRT may
be safer for patients with adverse conditions such as large tumors, central
tumors, and poor pulmonary function. Multi-institutional retrospective study
of CIRT for stage I NSCLC was completed and will be presented at ASTRO 2016
by the Japan Carbon-ion Radiation Oncology Study Group (J-CROS). Carbonion
therapy of locally advanced non-small cell lung cancer There was only one
report about CIRT for locally advanced NSCLC. A prospective nonrandomized
phase I/II study of CIRT in a favorable subset of locally advanced NSCLC
was reported from NIRS (9). They showed that short-course carbon-ion
monotherapy (72GyE/16Fr) was associated with manageable toxicity and
encouraging local control rates. Among them, cT3-4N0M0 patients were good
candidates for CIRT. There is otherwise a lack of evidence currently for CIRT
for locally advanced NSCLC, and more study is needed. Moreover, concurrent
systemic therapy is essential to improve survival for locally advanced NSCLC.
Future directions We organized a multi-institutional study group of carbonion
radiation oncology in Japan (J-CROS). This group is currently conducting
trials on several tumor sites which are thought to be most attractive for
CIRT, including NSCLC, head and neck disease, locally advanced unresectable
pancreatic cancer, hepatocellular carcinoma, locally recurrent rectal cancer,
and others. The outcomes of CIRT for stage I NSCLC at all Japanese carbon
centers were pooled and retrospectively analyzed. Consequently, CIRT may be
considered a low-risk and effective treatment option for patients with stage I
NSCLC. J-CROS has now begun a confirmatory multi-institutional prospective
study to confirm these results.References: 1. Kamada T, Tsujii H, Blakely EA,
et al. Carbon ion radiotherapy in Japan: an assessment of 20 years of clinical
experience. Lancet Oncol 2015; 16: e93-100.
2. Sawabata N, Miyaoka E, Asamura H, et al. Japanese lung cancer registry
study of 11,663 surgical cases in 2004: demographic and prognosis changes
over decade. J Thorac Oncol 2011; 6: 1229-35.
3. Miyamoto T, Yamamoto N, Nishimura H, et al. Carbon ionradiotherapy for
stage I non-small cell lung cancer. Radiother Oncol 2003; 66: 127-140.
4. Miyamoto T, Baba M, Yamamoto N, et al. Curative treatment of Stage I
non-small-cell lung cancer with carbon ion beams using a hypofractionated
regimen. Int J Radiation Oncol Biol Phys 2007; 67: 750-758.
5. Miyamoto T, Baba M, Sugane T, et al. Carbon ion radiotherapy for stage I
non-small cell lung cancer using a regimen of four fractions during 1 week. J
Thorac Oncol 2007; 10: 916-926.
6. Sugane T, Baba M, Imai R, et al. Carbon ion radiotherapy for elderly patients
80 years and older with stage I non-small cell lung cancer. Lung Cancer 2009;
64: 45-50.
7. Takahashi W, Nakajima M, Yamamoto N, et al. Carbon ion radiotherapy in a
hypofractionation regimen for stage I non-small-cell lung cancer. J Radiat Res
2014; 55(suppl 1): i26–i27.
8. Karube M, Yamamoto N, Nakajima M, et al. Single-fraction carbon-ion
radiation therapy for patients 80 years of age and older with stage I non-small
cell lung cancer. Int J Radiation Oncol Biol Phys 2016; 95: 542-548.
9. Takahashi W, Nakajima M, Yamamoto N, and et al. A prospective
nonrandomized phase I/II study of carbon ion radiotherapy in a favorable
subset of locally advanced non-small cell lung cancer (NSCLC). Cancer 2015;
121: 1321-7.
Ref.
Pts.
3) 81 72
Mean T1:
age T2
41:
41
4) 50 74.1
30:
21
5) 79 74.8
42:
37
6) 28 82
12:
17
7) 151 73.9 91:
60
8) 70 83
39:
31
Total dose
(GyRBE)
/ fractions
59.4-
95.4/
9-18
5-yr
F/U
local
(months)
control
5-yr
causespecific
survival
52.6 76% 60% 42%
5-yr Toxicity
overall
survival grade 3 <
lung
3.7%
72/ 9 59.2 94.7% 75.7% 50.0% skin
2%
52.8-
60/ 4
52.8-72/
4-9
38.6 90% 68% 45% 0%
NA 95.8% NA 30.7% 0%
36-50/ 1 45.6 79.2% NA 55.1% 0%
28-50/ 1 42.7 85.8% 64.9% 39.7% 0%
Keywords: carbon-ion therapy, non-small cell lung cancer, J-CROS
Copyright © 2016 by the International Association for the Study of Lung Cancer
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