Median follow up was 27.3 months for all patients, and 79.6 months for alive patients. At five years, the median OS was 26.5 months, and the corresponding five-year OS was 29 percent. Median progression-free survival was 12.9 months, with a five-year progression-free survival of 22 percent.

In sum, 39 patients experienced a relapse, with distant sites representing 62 percent of all recurrences. Local and regional recurrence rates were low, 16 percent and 14 percent, respectively.


Among the acute and late toxic effects diagnosed in patients were: esophagitis, pneumonitis and cardiac arrhythmia. Of note, said Chang, no patients developed the most severe, or grade five, toxicities, as seen in patients who receive standard of care.

Chang noted his study is not without limitations. Of greatest significance: the study was designed more than a decade ago. While the study’s survival, recurrence rates and toxic effects are still favorable when compared to rates associated with the most advanced traditional photon radiation therapy, intensity modulated radiation therapy (IMRT), technology to diagnose and stage the disease, as well all treatment modalities have significantly improved.

“When the study opened, PET imaging had just been approved for lung cancer staging. The image quality was poor and didn’t include a CT component in most facilities across the country,” said Chang. “Obviously, the technology has improved dramatically over the last decade and has made a significant impact on diagnosis and staging. Also, delivery of both the conventional intensity-modulated radiation therapy (IMRT) and proton therapy (IMPT), have improved, thereby reducing side effects for both treatment modalities.”

For example, MD Anderson proton therapy patients with advanced lung cancer now can receive IMPT. The technique uses an intricate network of magnets to aim a narrow proton beam at a tumor and “paint” the radiation dose onto it layer by layer. Healthy tissue surrounding the tumor is spared, and side effects are even more reduced than earlier proton delivery, said Chang.

A Phase II trial studying IMPT and concurrent chemotherapy is underway.

Chang also noted the advancements in cancer biology and immunotherapy and that both are important areas of research focus in combination with proton therapy.

In addition to Chang, other authors on the all-MD Anderson study include: Stephen Hahn, M.D., Ritsuko Komaki, M.D., Pamela K. Allen, Ph.D., Zhongxing Liao, M.D., Steven H. Lin, M.D., Ph.D., Daniel Gomez, M.D., James Welsh, M.D., Melenda Jeter M.D., James Cox, M.D., Michael O’Reilly, M.D., Ming Li, M.D. and Wencheng Zhang, M.D., all of Radiation Oncology; John V. Heymach, M.D., Ph.D. and Charles Lu, M.D., both of Thoracic/Head and Neck Medical Oncology; Ronald X. Zhu, Ph.D., Xiaodong Zhang, Ph.D., Heng Li, Ph.D., Radhe Mohan, Ph.D., all of Radiation Physics; and Ara A. Vaporciyan, M.D., Thoracic and Cardiovascular Surgery. Vivek Verma, M.D., now at the University of Nebraska Medical Center, also contributed to the study.

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