Open Access

High dose hypofractionated proton beam therapy is a safe and feasible treatment for central lung cancer

Takashi Ono
Takashi Ono
, 
Tomonori Yabuuchi
Tomonori Yabuuchi
, 
Tatsuya Nakamura
Tatsuya Nakamura
, 
Kanako Kimura
Kanako Kimura
, 
Yusuke Azami
Yusuke Azami
, 
Katsumi Hirose
Katsumi Hirose
, 
Motohisa Suzuki
Motohisa Suzuki
, 
Hitoshi Wada
Hitoshi Wada
, 
Yasuhiro Kikuchi
Yasuhiro Kikuchi
 and 
Kenji Nemoto
Kenji Nemoto
   | Jun 16, 2017
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Article Category: Research Article
Published Online: Jun 16, 2017
Page range: 324 - 330
Received: Jan 17, 2017
Accepted: May 14, 2017
DOI: https://doi.org/10.1515/raon-2017-0023
© 2017 Takashi Ono, Tomonori Yabuuchi, Tatsuya Nakamura, Kanako Kimura, Yusuke Azami, Katsumi Hirose, Motohisa Suzuki, Hitoshi Wada, Yasuhiro Kikuchi, Kenji Nemoto
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Dose distribution map of proton beam therapy for central lung cancer. The red line represents the gross tumor volume and the purple line around the tumor represents the 90% dose line. The region outside the outermost blue line is allocated to < 10% radiation.
Dose distribution map of proton beam therapy for central lung cancer. The red line represents the gross tumor volume and the purple line around the tumor represents the 90% dose line. The region outside the outermost blue line is allocated to < 10% radiation.

Figure 2

(A) The overall survival rate of the patients treated for central lung cancer. The 1- and 2-year overall survival rates were 95.0% and 73.8%, respectively. (B) The 2-year overall survival rates of operable and inoperable patients were 100% and 62.5%, respectively.
(A) The overall survival rate of the patients treated for central lung cancer. The 1- and 2-year overall survival rates were 95.0% and 73.8%, respectively. (B) The 2-year overall survival rates of operable and inoperable patients were 100% and 62.5%, respectively.

Figure 3

(A) The local control rate for patients with central lung cancer after proton beam therapy. The 2-year local control rate was 78.5%. (B) The 2-year local control rates of lung cancers with a diameter ≤ 39.5 mm and > 39.5 mm were 90% and 68.6%, respectively (p = 0.348).
(A) The local control rate for patients with central lung cancer after proton beam therapy. The 2-year local control rate was 78.5%. (B) The 2-year local control rates of lung cancers with a diameter ≤ 39.5 mm and > 39.5 mm were 90% and 68.6%, respectively (p = 0.348).

Overall survival of central lung cancer

Number of patients Median follow up time treatment Overall survival rate All grade 3-5 toxicities
Song et al. (20) 9 26.5 months SBRT 50% (2-year) 33%
Modh et al. (21) 125 17.4 months SBRT 64% (2-year) 8%
Chaudhuri et al. (22) 34 18.4 months SBRT 63.2% (2-year) 3%
Tekatli et al. (23) 80 47 months SBRT 53% (3-year) 6.4%
Bush et al. (8) 33 48 months PBT Not applicable 0
present study 20 27.5 months PBT 73.8% (2-year) 0

Toxicities

Toxicities Grade 0 Grade 1 Grade 2 Grade 3 - 5
Lung 0 18 (90%) 2 (1 0%) 0
Esophagus 20 (100%) 0 0 0
Heart 16 (80%) 4 (20%) 0 0
Bone 15 (75%) 3 (15%) 2 (10%) 0

The patient characteristics (n = 20)

Characteristics Patients
Age (years)
Median (range) 75 (63–90)
Gender
   Male 17 (85%)
   Female 3 (15%)
Performance status
   0 8 (40%)
   1 8 (40%)
   2 4 (20%)
Charlson Index
   0 5 (25%)
   1 6 (30%)
   2 7 (35%)
   3 2 (10%)
Follow-up time (months)
Median (range) 27.5 (12-72)
Chronic obstructive pulmonary disease
   Yes 9 (45%)
   No 11 (55%)
T category

Numbers correspond to the tumor-node-metastasis system of classification (International Union Against Cancer criteria)
   T1 4 (20%)
   T2 11 (55%)
   T3 4 (20%)
   T4 1 (5%)
Stage

Numbers correspond to the tumor-node-metastasis system of classification (International Union Against Cancer criteria)
   I 15 (75%)
   II 4 (20%)
   III 1 (5%)
Tumor location
   Right upper lobe 7 (35%)
   Right middle lobe 2 (10%)
   Right lower lobe 6 (30%)
   Left upper lobe 3 (15%)
   Left lower lobe 2 (10%)
Histopathology
   Squamous cell carcinoma 8 (40%)
   Adenocarcinoma 5 (25%)
   Clinical malignancy 7 (35%)
Diameter of lung tumor (mm)
   Median (range) 39.5 (24-81)
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