Background: Hypofractionated proton beam radiotherapy (PBT) is gaining attention in early-stage non-small cell lung cancer (ES-NSCLC). However, there is a large unmet need to define indications, prescription doses and potential adverse events of protons in this clinical scenario. Hence, the present work aims to provide a critical literature revision, and to investigate associations between fractionation schedules/ biological effective doses (BEDs), oncological outcomes and toxicities.Materials and methods: This systematic review and meta-analysis complied with the PRISMA recommendations. Inclusion criteria were: 1) curative-intent hypofractionated PBT for ES-NSCLC (>= 3 Gy(RBE)/fraction), 2) report of the clinical outcomes of interest, 3) availability of full-text written in English. The bibliographic search was performed on the NCBI Pubmed, Embase and Scopus in September 2021; no other limitations were applied. The BED was calculated for each included study (alpha/beta = 10 Gy); the median BED for all studies was used as a threshold for stratifying selected evidence into "high" and "low"-dose subgroups. Heterogeneity was tested using chi-square statistics; inconsistency was measured with the I2 index. Pooled estimate was obtained by fitting both the fixed-effect and the DerSimonian and Laird random-effect model.Results: Eight studies and 401 patients were available for the meta-analysis; median follow-up was 32.8 months. The median delivered BED was 105.6 Gy(RBE). A BED >= 105.6 Gy(RBE) consistently provided superior OS, CSS, DFS and LC rates (i.e.: 4-year OS: 0.56 [0.34-0.76] for BED < 105.6 Gy(RBE) and 0.78 [0.64-0.88] for BED >= 105.6 Gy(RBE)). The meta-analysis of proportions showed a comparable probability of developing acute grade >= 2 toxicity between the two groups, while the probability of any late grade >= 2 event was almost three-times greater for BED >= 105.6 Gy(RBE), with rib fractures being more common in the high dose group.Conclusion: Hypofractionated PBT is a safe and effective treatment option for ES-NSCLC; the delivery of BED >= 105.6 Gy(RBE) with advanced techniques for uncertainty management has been associated with improved oncological outcomes across all considered time points.

Volpe, S., Piperno, G., Colombo, F., Biffi, A., Comi, S., Mastroleo, F., et al. (2022). Hypofractionated proton therapy for non-small cell lung cancer: Ready for prime time? A systematic review and meta-analysis. CANCER TREATMENT REVIEWS, 110(November 2022) [10.1016/j.ctrv.2022.102464].

Hypofractionated proton therapy for non-small cell lung cancer: Ready for prime time? A systematic review and meta-analysis

Biffi, Annalisa;
2022

Abstract

Background: Hypofractionated proton beam radiotherapy (PBT) is gaining attention in early-stage non-small cell lung cancer (ES-NSCLC). However, there is a large unmet need to define indications, prescription doses and potential adverse events of protons in this clinical scenario. Hence, the present work aims to provide a critical literature revision, and to investigate associations between fractionation schedules/ biological effective doses (BEDs), oncological outcomes and toxicities.Materials and methods: This systematic review and meta-analysis complied with the PRISMA recommendations. Inclusion criteria were: 1) curative-intent hypofractionated PBT for ES-NSCLC (>= 3 Gy(RBE)/fraction), 2) report of the clinical outcomes of interest, 3) availability of full-text written in English. The bibliographic search was performed on the NCBI Pubmed, Embase and Scopus in September 2021; no other limitations were applied. The BED was calculated for each included study (alpha/beta = 10 Gy); the median BED for all studies was used as a threshold for stratifying selected evidence into "high" and "low"-dose subgroups. Heterogeneity was tested using chi-square statistics; inconsistency was measured with the I2 index. Pooled estimate was obtained by fitting both the fixed-effect and the DerSimonian and Laird random-effect model.Results: Eight studies and 401 patients were available for the meta-analysis; median follow-up was 32.8 months. The median delivered BED was 105.6 Gy(RBE). A BED >= 105.6 Gy(RBE) consistently provided superior OS, CSS, DFS and LC rates (i.e.: 4-year OS: 0.56 [0.34-0.76] for BED < 105.6 Gy(RBE) and 0.78 [0.64-0.88] for BED >= 105.6 Gy(RBE)). The meta-analysis of proportions showed a comparable probability of developing acute grade >= 2 toxicity between the two groups, while the probability of any late grade >= 2 event was almost three-times greater for BED >= 105.6 Gy(RBE), with rib fractures being more common in the high dose group.Conclusion: Hypofractionated PBT is a safe and effective treatment option for ES-NSCLC; the delivery of BED >= 105.6 Gy(RBE) with advanced techniques for uncertainty management has been associated with improved oncological outcomes across all considered time points.
Articolo in rivista - Articolo scientifico
Biological effective dose; Hypofractionation; Meta-analysis; Non-small cell lung cancer; Proton beam therapy;
English
20-set-2022
2022
110
November 2022
102464
none
Volpe, S., Piperno, G., Colombo, F., Biffi, A., Comi, S., Mastroleo, F., et al. (2022). Hypofractionated proton therapy for non-small cell lung cancer: Ready for prime time? A systematic review and meta-analysis. CANCER TREATMENT REVIEWS, 110(November 2022) [10.1016/j.ctrv.2022.102464].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/417945
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