Immune System Dose With Proton Versus Photon Radiotherapy for Treatment of Locally Advanced NSCLC

Overview

Journal Int J Part Ther

Publisher Elsevier

Specialty Radiology

Date 2024 Jun 4

PMID 38832321

Authors

Jimmy S Patel

Neal S McCall

Matthew Thomas

Jun Zhou

Kristin A Higgins

Jeffrey D Bradley

Sibo Tian

Mark W McDonald

Aparna H Kesarwala

William A Stokes

Affiliations

Soon will be listed here.

Abstract

Purpose: Emerging data have illuminated the impact of effective radiation dose to immune cells (EDIC) on outcomes in patients with locally advanced, unresectable non-small cell lung cancer (NSCLC) treated with intensity-modulated radiotherapy (IMRT). Hypothesizing that intensity-modulated proton therapy (IMPT) may reduce EDIC versus IMRT, we conducted a dosimetric analysis of patients treated at our institution.

Materials And Methods: Data were retrospectively collected for 12 patients with locally advanced, unresectable NSCLC diagnosed between 2019 and 2021 who had physician-approved IMRT and IMPT plans. Data to calculate EDIC from both Jin et al (PMID: 34944813) and Ladbury et al's (PMID: 31175902) models were abstracted. Paired tests were utilized to compare the difference in mean EDIC between IMPT and IMRT plans.

Results: IMPT decreased EDIC for 11 of 12 patients (91.7%). The mean EDIC per the Jin model was significantly lower with IMPT than IMRT (3.04 GyE vs 4.99 Gy, < .001). Similarly, the mean EDIC per the Ladbury model was significantly lower with IMPT than IMRT (4.50 GyE vs 7.60 Gy, < .002). Modeled 2-year overall survival was significantly longer with IMPT than IMRT (median 71% vs 63%; = .03).

Conclusion: IMPT offers a statistically significant reduction in EDIC compared to IMRT. Given the emergence of EDIC as a modifiable prognostic factor in treatment planning, our dosimetric study highlights a potential role for IMPT to address an unmet need in improving oncologic outcomes in patients with locoregionally advanced NSCLC.

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