BACKGROUND AND PURPOSE: To compare time-dependent changes in lung parenchyma of early-stage non-small cell lung carcinoma (NSCLC) patients after stereotactic body radiation therapy with protons (SBPT) or photons (SBRT). MATERIALS AND METHOD: We retrospectively identified NSCLC patients treated with SBPT and matched each one with a SBRT patient by patient, tumor, and treatment characteristics. Lung parenchyma on serial post-treatment chest computer tomography (CT) scans was deformably registered with the treatment plan to analyze lung density changes as function of dose, quantified by Houndsfield Unit (HU)/Gy. A thoracic radiologist also evaluated the CTs using an established grading system. RESULTS: We matched 23 SBPT/SBRT pairs, including 5 patients treated with both modalities (internally matched cohort). Normal lung response following SBPT significantly increased in the early time period (CTs acquired <6 months, median 3 months) post-treatment, and then did not change significantly in the later time period (CTs acquired 6-14 months, median 9 months). For SBRT, the normal lung response was similar to SBPT in the early time period, but then increased significantly from the early to the late time period (p = 0.007). These differences were most pronounced in sensitive (response >6 HU/Gy) patients and in the internally matched cohort. However, there was no significant difference in the maximum observed response in the entire cohort over all time periods, median 3.4 [IQR, 1.0-5.4] HU/Gy (SBPT) versus 2.5 [1.6-5.2] HU/Gy (SBRT). Qualitative radiological evaluation was highly correlated with the quantitative analysis (p < 0.0001). CONCLUSION: While there was no significant difference in maximum response after SBPT versus SBRT, dose-defined lung inflammation occurred earlier after proton irradiation. Further investigation is warranted into the mechanisms of inflammation and therapeutic consequences after proton versus photon irradiation.
BACKGROUND AND PURPOSE: To compare time-dependent changes in lung parenchyma of early-stage non-small cell lung carcinoma (NSCLC) patients after stereotactic body radiation therapy with protons (SBPT) or photons (SBRT). MATERIALS AND METHOD: We retrospectively identified NSCLCpatients treated with SBPT and matched each one with a SBRT patient by patient, tumor, and treatment characteristics. Lung parenchyma on serial post-treatment chest computer tomography (CT) scans was deformably registered with the treatment plan to analyze lung density changes as function of dose, quantified by Houndsfield Unit (HU)/Gy. A thoracic radiologist also evaluated the CTs using an established grading system. RESULTS: We matched 23 SBPT/SBRT pairs, including 5 patients treated with both modalities (internally matched cohort). Normal lung response following SBPT significantly increased in the early time period (CTs acquired <6 months, median 3 months) post-treatment, and then did not change significantly in the later time period (CTs acquired 6-14 months, median 9 months). For SBRT, the normal lung response was similar to SBPT in the early time period, but then increased significantly from the early to the late time period (p = 0.007). These differences were most pronounced in sensitive (response >6 HU/Gy) patients and in the internally matched cohort. However, there was no significant difference in the maximum observed response in the entire cohort over all time periods, median 3.4 [IQR, 1.0-5.4] HU/Gy (SBPT) versus 2.5 [1.6-5.2] HU/Gy (SBRT). Qualitative radiological evaluation was highly correlated with the quantitative analysis (p < 0.0001). CONCLUSION: While there was no significant difference in maximum response after SBPT versus SBRT, dose-defined lung inflammation occurred earlier after proton irradiation. Further investigation is warranted into the mechanisms of inflammation and therapeutic consequences after proton versus photon irradiation.
Authors: Quentin Diot; Lawrence B Marks; Soren M Bentzen; Suresh Senan; Brian D Kavanagh; Michael V Lawrence; Moyed Miften; David A Palma Journal: Int J Radiat Oncol Biol Phys Date: 2014-07-01 Impact factor: 7.038
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Authors: John J Cuaron; Chang Chang; Michael Lovelock; Daniel S Higginson; Dennis Mah; Oren Cahlon; Simon Powell Journal: Int J Radiat Oncol Biol Phys Date: 2016-02-13 Impact factor: 7.038
Authors: Antonia E Wuschner; Eric M Wallat; Mattison J Flakus; Dhanansayan Shanmuganayagam; Jennifer Meudt; Gary E Christensen; Joseph M Reinhardt; Jessica R Miller; Michael J Lawless; Andrew M Baschnagel; John E Bayouth Journal: Sci Rep Date: 2021-06-23 Impact factor: 4.996
Authors: Harald Paganetti; Chris Beltran; Stefan Both; Lei Dong; Jacob Flanz; Keith Furutani; Clemens Grassberger; David R Grosshans; Antje-Christin Knopf; Johannes A Langendijk; Hakan Nystrom; Katia Parodi; Bas W Raaymakers; Christian Richter; Gabriel O Sawakuchi; Marco Schippers; Simona F Shaitelman; B K Kevin Teo; Jan Unkelbach; Patrick Wohlfahrt; Tony Lomax Journal: Phys Med Biol Date: 2021-02-26 Impact factor: 4.174