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Radiation Oncology
Published in: Radiation Oncology 1/2017

Open Access 01-12-2017 | Research

Carbon-ion radiotherapy for non-small cell lung cancer with interstitial lung disease: a retrospective analysis

Authors: Mio Nakajima, Naoyoshi Yamamoto, Kazuhiko Hayashi, Masataka Karube, Daniel K Ebner, Wataru Takahashi, Makoto Anzai, Kenji Tsushima, Yuji Tada, Koichiro Tatsumi, Tadaaiki Miyamoto, Hiroshi Tsuji, Takehiko Fujisawa, Tadashi Kamada

Published in: Radiation Oncology | Issue 1/2017

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Abstract

Background

Lung cancer is frequently complicated by interstitial lung disease (ILD). Treatment protocols for lung cancer patients with ILD have not been established; surgery, chemotherapy, and radiotherapy can all cause acute exacerbation of ILD. This study evaluated the toxicity and efficacy of carbon ion radiotherapy (CIRT) in patients with non-small cell lung cancer (NSCLC) and ILD.

Methods

Between June 2004 and November 2014, 29 patients diagnosed with NSCLC and ILD were treated with CIRT. No patient was eligible for curative surgery or conventional radiotherapy secondary to ILD. Owing to prior symptomology, radiation pneumonitis (RP) and symptom progression pre- and post-treatment were evaluated. The relationships between RP and clinical factors were investigated.

Results

Twenty-eight men and one woman, aged 62 to 90 years old, were followed for 2.7–77.1 months (median: 22.8 months). Single-grade symptomatic progression (grade 2–3) was observed in 4 patients, while 1 patient experiencedtwo-grade progression. Two patients experienced radiation-induced acute exacerbation. Local control at 3 years was 63.3% (72.2% for stage I disease); survival at 3 years was 46.3% (57.2% for stage I disease). Eighteen patients had died by the time of this writing, 10 of lung cancer progression. Radiation pneumonitis post-treatment progression correlated with dosimetric factors of the lungs (V5, V10) and a low pre-treatment serum surfactant protein-D.

Conclusions

We found that CIRT may be useful as a low-risk, curative option for NSCLC patients with ILD, a population that is typically ineligible for conventional therapy. The DVH analysis showed that minimizing the low-dose region is important for reducing the risk of severe RP.

Trial registration

NIRS-9404. Registered 1 March 1994.
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Metadata
Title
Carbon-ion radiotherapy for non-small cell lung cancer with interstitial lung disease: a retrospective analysis
Authors
Mio Nakajima
Naoyoshi Yamamoto
Kazuhiko Hayashi
Masataka Karube
Daniel K Ebner
Wataru Takahashi
Makoto Anzai
Kenji Tsushima
Yuji Tada
Koichiro Tatsumi
Tadaaiki Miyamoto
Hiroshi Tsuji
Takehiko Fujisawa
Tadashi Kamada
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2017
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-017-0881-1

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