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Effects of Proton and Combined Proton/Photon Beam Radiation on Pulmonary Function in Patients With Resectable but Medically Inoperable Non-small Cell Lung Cancer^*

^* From the Department of Pulmonary Medicine (Dr. Bonnet), Zentralklinik Bad Berka GmbH, Bad Berka, Germany; and Division of Pulmonary and Critical Care Medicine (Drs. Cheek, Panossian, and Franke), and Department of Radiation Medicine (Drs. Bush, J.D. Slater, and J.M. Slater), Loma Linda University, Loma Linda, CA.

Correspondence to: Reiner B. Bonnet, MD, Zentralklinik Bad Berka GmbH, Klinik für Pneumologie, Robert Koch Allee 9, 99438 Bad Berka, Germany; e-mail: r.bonnet.pn{at}zentralklinik-bad-berka.de

Study objectives: We evaluated the effects on pulmonary function of irradiating lung cancer with protons alone or protons combined with photons.

Design: Prospective phase I/II study.

Setting: University medical center.

Patients and interventions: Ten patients with stage I-II non-small cell lung cancer (NSCLC) and FEV₁ 1.0 L were irradiated with protons to areas of gross disease only, using 51 cobalt gray equivalents (CGE) in 10 fractions (protocol 1). Fifteen patients with stage I-IIIA NSCLC and FEV₁ > 1.0 L received 45-Gy photon irradiation to the primary lung tumor and the mediastinum, plus a 28.8-CGE proton boost to the gross tumor volume (protocol 2).

Measurements: Pulmonary function was evaluated prior to treatment and 1 month, 3 months, and 6 to 12 months following irradiation.

Results: In patients receiving protocol 1, no significant changes in pulmonary function occurred. In patients receiving protocol 2, at 6 to 12 months, the diffusion capacity of the lung for carbon monoxide had declined from 61% of predicted to 45% of predicted (p < 0.05), total lung capacity had declined from 114% of predicted to 95% of predicted (p < 0.05), and residual volume had declined from 160% of predicted to 132% of predicted (p < 0.05). Airway resistance increased from 3.8 to 5.2 cm H₂O/L/s (p < 0.05). No statistically significant changes occurred in vital capacity, FEV₁, or PaO₂.

Conclusions: Our observations indicate that it is feasible to apply higher-than-conventional doses of radiation at a higher-than-conventional dose per fraction without excess pulmonary toxicity when conformal radiation techniques with protons are used.

Key Words: irradiation • lung cancer treatment • non-small cell lung cancer • photon • proton • radiation

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