Preliminary Safety and Efficacy of Proton Plus Carbon-Ion Radiotherapy With Concurrent Chemotherapy in Limited-Stage Small Cell Lung Cancer

Ning-Yi Ma; Jian Chen; Xue Ming; Guo-Liang Jiang; Jiade J Lu; Kai-Liang Wu; Jingfang Mao

doi:10.3389/fonc.2021.766822

Preliminary Safety and Efficacy of Proton Plus Carbon-Ion Radiotherapy With Concurrent Chemotherapy in Limited-Stage Small Cell Lung Cancer

Front Oncol. 2021 Nov 11:11:766822. doi: 10.3389/fonc.2021.766822. eCollection 2021.

Authors

Ning-Yi Ma^{1

2

3}, Jian Chen^{1

2

3}, Xue Ming^{2

3

4}, Guo-Liang Jiang^{2

3

5}, Jiade J Lu^{1

2

3}, Kai-Liang Wu^{2

3

5}, Jingfang Mao^{2

3

5}

Affiliations

¹ Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.
² Department of Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.
³ Department of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.
⁴ Department of Radiation Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.
⁵ Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Fudan University, Shanghai, China.

Abstract

Objectives: This study aimed to investigate the tolerance and effect of proton plus carbon-ion radiotherapy with concurrent chemotherapy in limited-stage small cell lung cancer using the pencil beam scanning technique.

Materials and methods: From March 2017 to April 2020, 25 patients with limited-stage small cell lung cancer treated with combined proton and carbon-ion radiotherapy were analyzed. The primary lesions and involved lymph nodes were irradiated using 2-4 portals. Proton and sequential carbon-ion beams were delivered with a median dose of 67.1 (range, 63-74.8) GyE as fraction doses of 2.0-2.2 GyE with proton beams in 20-23 fractions and 3.0-3.8 GyE with carbon ions in 5-8 fractions. Chemotherapy was delivered concurrently with radiotherapy in all patients.

Results: At the last follow-up, the 2-year overall and locoregional progression-free survival rates were 81.7% and 66.7%, respectively. Radiochemotherapy was well tolerated, with grade 1, 2, and 3 acute toxicities occurring in 12.0%, 68.0%, and 20.0% of patients, respectively. All grade 3 acute toxicities were hematologically related changes. One patient experienced grade 3 acute non-hematological toxicity in the esophagus, and one other patient had grade 3 bronchial obstruction accompanied by obstructive atelectasis as a late side effect.

Conclusion: Proton plus carbon-ion radiotherapy using pencil beam scanning yielded promising survival rates and tolerability in patients with limited-stage small cell lung cancer. A prospective clinical study is warranted to validate the therapeutic efficacy of particle radiotherapy in combination with chemotherapy in limited-stage small cell lung cancer.

Keywords: carbon ion; efficacy; proton; radiotherapy; small cell lung cancer.