Differential inflammatory response dynamics in normal lung following stereotactic body radiation therapy with protons versus photons.
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung
/ diagnostic imaging
Female
Humans
Inflammation
/ etiology
Lung
/ radiation effects
Lung Neoplasms
/ diagnostic imaging
Male
Middle Aged
Photons
/ adverse effects
Proton Therapy
/ adverse effects
Radiosurgery
/ adverse effects
Retrospective Studies
Tomography, X-Ray Computed
Dose–response relationship
Proton therapy
Radiation pneumonitis
Radiosurgery
Journal
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
ISSN: 1879-0887
Titre abrégé: Radiother Oncol
Pays: Ireland
ID NLM: 8407192
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
19
11
2018
revised:
29
03
2019
accepted:
03
04
2019
pubmed:
25
4
2019
medline:
1
4
2020
entrez:
25
4
2019
Statut:
ppublish
Résumé
To compare time-dependent changes in lung parenchyma of early-stage non-small cell lung carcinoma (NSCLC) patients after stereotactic body radiation therapy with protons (SBPT) or photons (SBRT). We retrospectively identified NSCLC patients treated with SBPT and matched each one with a SBRT patient by patient, tumor, and treatment characteristics. Lung parenchyma on serial post-treatment chest computer tomography (CT) scans was deformably registered with the treatment plan to analyze lung density changes as function of dose, quantified by Houndsfield Unit (HU)/Gy. A thoracic radiologist also evaluated the CTs using an established grading system. We matched 23 SBPT/SBRT pairs, including 5 patients treated with both modalities (internally matched cohort). Normal lung response following SBPT significantly increased in the early time period (CTs acquired <6 months, median 3 months) post-treatment, and then did not change significantly in the later time period (CTs acquired 6-14 months, median 9 months). For SBRT, the normal lung response was similar to SBPT in the early time period, but then increased significantly from the early to the late time period (p = 0.007). These differences were most pronounced in sensitive (response >6 HU/Gy) patients and in the internally matched cohort. However, there was no significant difference in the maximum observed response in the entire cohort over all time periods, median 3.4 [IQR, 1.0-5.4] HU/Gy (SBPT) versus 2.5 [1.6-5.2] HU/Gy (SBRT). Qualitative radiological evaluation was highly correlated with the quantitative analysis (p < 0.0001). While there was no significant difference in maximum response after SBPT versus SBRT, dose-defined lung inflammation occurred earlier after proton irradiation. Further investigation is warranted into the mechanisms of inflammation and therapeutic consequences after proton versus photon irradiation.
Sections du résumé
BACKGROUND AND PURPOSE
To compare time-dependent changes in lung parenchyma of early-stage non-small cell lung carcinoma (NSCLC) patients after stereotactic body radiation therapy with protons (SBPT) or photons (SBRT).
MATERIALS AND METHOD
We retrospectively identified NSCLC patients treated with SBPT and matched each one with a SBRT patient by patient, tumor, and treatment characteristics. Lung parenchyma on serial post-treatment chest computer tomography (CT) scans was deformably registered with the treatment plan to analyze lung density changes as function of dose, quantified by Houndsfield Unit (HU)/Gy. A thoracic radiologist also evaluated the CTs using an established grading system.
RESULTS
We matched 23 SBPT/SBRT pairs, including 5 patients treated with both modalities (internally matched cohort). Normal lung response following SBPT significantly increased in the early time period (CTs acquired <6 months, median 3 months) post-treatment, and then did not change significantly in the later time period (CTs acquired 6-14 months, median 9 months). For SBRT, the normal lung response was similar to SBPT in the early time period, but then increased significantly from the early to the late time period (p = 0.007). These differences were most pronounced in sensitive (response >6 HU/Gy) patients and in the internally matched cohort. However, there was no significant difference in the maximum observed response in the entire cohort over all time periods, median 3.4 [IQR, 1.0-5.4] HU/Gy (SBPT) versus 2.5 [1.6-5.2] HU/Gy (SBRT). Qualitative radiological evaluation was highly correlated with the quantitative analysis (p < 0.0001).
CONCLUSION
While there was no significant difference in maximum response after SBPT versus SBRT, dose-defined lung inflammation occurred earlier after proton irradiation. Further investigation is warranted into the mechanisms of inflammation and therapeutic consequences after proton versus photon irradiation.
Identifiants
pubmed: 31015121
pii: S0167-8140(19)30163-X
doi: 10.1016/j.radonc.2019.04.004
pmc: PMC6592748
mid: NIHMS1526747
pii:
doi:
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
169-175Subventions
Organisme : NCI NIH HHS
ID : P01 CA021239
Pays : United States
Organisme : NCI NIH HHS
ID : U19 CA021239
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.
Références
J Clin Oncol. 2018 Jun 20;36(18):1813-1822
pubmed: 29293386
Int J Radiat Oncol Biol Phys. 2018 Nov 15;102(4):1287-1298
pubmed: 29908943
J Thorac Dis. 2018 Aug;10(Suppl 21):S2451-S2464
pubmed: 30206491
Int J Radiat Oncol Biol Phys. 2006 Dec 1;66(5):1281-93
pubmed: 17126203
Int J Radiat Oncol Biol Phys. 2016 May 1;95(1):62-69
pubmed: 27084629
Phys Med Biol. 2014 Nov 21;59(22):R419-72
pubmed: 25361443
J Thorac Oncol. 2012 Jun;7(6):1021-5
pubmed: 22551902
Radiother Oncol. 2018 Jul;128(1):115-120
pubmed: 29573823
Radiother Oncol. 2018 Jul;128(1):68-75
pubmed: 29910006
Int J Radiat Oncol Biol Phys. 2014 Jul 1;89(3):626-32
pubmed: 24929168
Int J Radiat Oncol Biol Phys. 1999 Feb 1;43(3):489-96
pubmed: 10078627
JAMA Oncol. 2018 Feb 1;4(2):253-255
pubmed: 28973343
Semin Radiat Oncol. 2010 Jul;20(3):201-7
pubmed: 20685583
Med Phys. 2013 Aug;40(8):081712
pubmed: 23927309
Radiother Oncol. 2018 Jul;128(1):147-153
pubmed: 29352608
Nat Rev Cancer. 2018 May;18(5):313-322
pubmed: 29449659
Radiother Oncol. 2016 Dec;121(3):395-401
pubmed: 27863964
Int J Radiat Oncol Biol Phys. 2018 Jul 15;101(4):809-819
pubmed: 29976493
Int J Radiat Oncol Biol Phys. 2016 May 1;95(1):86-94
pubmed: 26452569
Acta Oncol. 2017 Nov;56(11):1387-1391
pubmed: 28830292
Int J Radiat Oncol Biol Phys. 2012 Nov 15;84(4):1024-30
pubmed: 22583607
Cancer Res. 2014 Sep 15;74(18):5070-8
pubmed: 25038226
Radiother Oncol. 2013 Oct;109(1):89-94
pubmed: 24060177
Radiother Oncol. 2012 Apr;103(1):8-11
pubmed: 22405807
Transl Lung Cancer Res. 2017 Apr;6(2):178-185
pubmed: 28529900