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Publications

Journal Article Epublish

PubMed: 42787797 DOI: 10.1016/j.ctro.2026.101291

Hypofractionated and stereotactic body proton radiotherapy for a high-risk lung cancer cohort: A multi-institutional experience from the proton collaborative group prospective registry.

Clin Transl Radiat Oncol 62:101291

Authors: Alexander J Allen, Charles B Simone, Kai Sun, David F Alicia, Ajay Banskota, Gopal K Bajaj, John H Chang, James R Gray, Ryan S Grover, Christian C Hyde, Jenna B Jatczak, Kara E Lehman, Mark W McDonald, Stephen A Mihalcik, Sina Mossahebi, Michelle R Mundis Myers, Yosan G Okbamichael, Stephanie M Perkins, Robert H Press, Zaker H Rana, Lane R Rosen, Ronny L Rotondo, Christopher C Sinesi, Henry K Tsai, James J Urbanic, Carlos E Vargas, Nathan Y Yu, Jing Zeng, Matthew J Ferris

Affiliations

  • Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, United States of America.
  • Maryland Proton Treatment Center, Baltimore, MD, United States of America.
  • Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY, United States of America.
  • Inova Schar Cancer Institute, Department for Advanced Radiation Oncology and Proton Therapy, Fairfax, VA, United States of America.
  • Oklahoma Proton Center, Oklahoma City, OK, United States of America.
  • Tennessee Oncology Proton Center, Nashville, TN, United States of America.
  • Covenant Health, Thompson Proton Center, Knoxville, TN, United States of America.
  • McLaren Proton Therapy Center, Flint, MI, United States of America.
  • Emory Proton Therapy Center, Atlanta, GA, United States of America.
  • Northwestern Feinberg School of Medicine, Department of Radiation Oncology, Chicago, IL, United States of America.
  • Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO, United States of America.
  • Baptist Health South Florida Miami Cancer Institute, Miami, FL, United States of America.
  • Willis Knighton Health, Shreveport, LA, United States of America.
  • University of Kansas Medical Center, Department of Radiation Oncology, Kansas City, KS, United States of America.
  • Hampton University Proton Cancer Institute, Hampton, VA, United States of America.
  • ProCure Proton Therapy Center, Somerset, NJ, United States of America.
  • University of California San Diego Health, Department of Radiation Oncology, Encinitas, CA, United States of America.
  • Mayo Clinic Comprehensive Cancer Center, Department of Radiation Oncology, Phoenix, AZ, United States of America.
  • University of Washington Medical Center, Department of Radiation Oncology, Seattle, WA, United States of America.

Abstract

INTRODUCTION

Lung cancer is commonly treated with stereotactic body radiotherapy (SBRT) and hypofractionated RT (HFRT). Delivering these ablative regimens with proton beam therapy (PBT) may yield dosimetric and clinical advantages, particularly for high-risk cases. We evaluated safety and efficacy of SBRT/HFRT PBT for lung tumors, including unfavorable subgroups.

METHODS

Adults with lung tumors treated with PBT ≤15 fractions were identified from a prospective, multi-institutional registry. Eligible regimens included 4-5 fractions at ≥10Gy/fraction (≥48Gy total) or 8-15 fractions at ≥3.5Gy/fraction (≥52.5Gy total). Local control (LC) was estimated using cumulative incidence with death as a competing risk, and Fine-Gray models were used for subgroup comparisons.

RESULTS

104 patients with 110 tumors (83.6% non-small cell lung cancer) were included: 32.7% ≥4 cm, 41.8% ultracentral, and 30% re-irradiated. Most common regimens were 60Gy/15 fractions (40%) and 50Gy/5 fractions (17.2%); 71.8% received intensity-modulated PBT. 1-and 2-year LC rates were 83.1% and 77.4%, with no difference by tumor size, ultracentral location, or re-irradiation. Internal gross tumor volume receiving 95% of dose was associated with improved LC (p = 0.007). Most common toxicities were cough (40%) and dyspnea (34.5%), with no Grade ≥ 3 events.

CONCLUSIONS

In the largest prospectively enrolled report of SBRT/HFRT via intensity-modulated PBT for a high-risk lung tumor cohort, 1- and 2-year LC rates were 83.1% and 77.4%, with no grade ≥ 3 toxicities. LC was similar among high-risk subgroups. However, short survival and follow-up durations limited assessment of the findings. Despite the prospective registry, reliable long-term follow-up data remained limited for many patients, somewhat restricting result interpretation.

MeSH

Registries, Radiotherapy, Proton Therapy, Lung, Neoplasms, Multiple Chronic Conditions, Lung Neoplasms, Therapeutics