Impact of unfavorable factors on outcomes among inoperable stage II-IV Nonsmall cell lung cancer patients treated with proton therapy

Authors

  • He J. Zhu Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
  • Romaine C. Nichols Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
  • Randal H. Henderson Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA;
  • Christopher G. Morris Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
  • Stella Flampouri Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
  • Dat C. Pham Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
  • Christopher L. Klassen Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, USA;
  • Vandana Seeram Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
  • James D. Cury Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
  • Lisa Jones Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
  • Lisa McGee Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
  • Bradford S. Hoppe Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA

DOI:

https://doi.org/10.1080/0284186X.2018.1546060

Abstract

Purpose: To investigate the impact of unfavorable risk factors among patients with locally advanced nonsmall cell lung cancer (LA-NSCLC) treated with proton therapy (PT).

Material and Methods: From May 2008 through July 2015, 90 consecutive patients with unresectable stage II-IV (oligometastatic) NSCLC were treated with PT. Unfavorable factors including age ≥80 years, stage IV, weight loss >10% in 3 months, performance status (PS) ≥2, FEV1 < 1.0 or O2 dependency, prior lung cancer, prior lung surgery, prior 2nd cancer in the past 3 years, and prior chest irradiation were evaluated. All patients received standard fractionation of 1.8–2 Gy(RBE) (median dose, 70 Gy[RBE]). Overall survival (OS) and progression-free survival (PFS) were calculated with the Kaplan-Meier method. The impact of unfavorable factors was analyzed in Cox regression models.

Results: Twenty-six percent were favorable-risk, while 42%, 22%, and 10% had 1-, 2-, or ≥3 unfavorable factors. The 2-year OS was 52% and 45% (p = .8522), and 2-year PFS was 21% and 44% (p = .0207), for favorable and unfavorable risk patients, respectively. Among patients with stage III-IV, only PS ≥2 adversely impacted OS (p = .0015).

Conclusion: Most patients treated with PT for LA-NSCLC have unfavorable risk factors. These patients had similar outcomes to favorable-risk patients. Enrollment in future clinical trials may improve if eligibility is less restrictive.

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Published

2019-03-04

How to Cite

Zhu, H. J., Nichols, R. C. ., Henderson, R. H. ., Morris, C. G. ., Flampouri, S. ., Pham, D. C. ., … Hoppe, B. S. . (2019). Impact of unfavorable factors on outcomes among inoperable stage II-IV Nonsmall cell lung cancer patients treated with proton therapy. Acta Oncologica, 58(3), 313–319. https://doi.org/10.1080/0284186X.2018.1546060

Issue

Vol. 58 No. 3 (2019): Acta Oncologica

Section

Articles