SAN DIEGO—Two studies presented at the 52nd annual meeting of the American Society for Radiation Oncology have found that the use of fast neutron radiotherapy (FNRT), a form of radiation that is about three times more powerful than typical photon radiotherapy, is highly effective and safe for patients with non–small-cell lung cancer (NSCLC).
Researchers analyzed results for NSCLC patients who were treated at a single institution from 1993 to 2006. Treatments included a combination of fast neutron and photon radiotherapy. FNRT lost favor in the medical community in the past because, in some cancer patients, delivering FNRT resulted in higher toxicities.
“There are only five centers in the world that are using fast neutron therapy,” said study investigator Andre Konski, MD, MBA, who is professor and chair of the Department of Radiation Oncology at Wayne State University School of Medicine, Detroit, Michigan. “It is able to treat tumors that are resistant to photon radiotherapy.”
Konski said 20% to 30% of lung cancer patients do not respond to photon radiotherapy and still have significant symptoms. “They still need to have their symptoms palliated, and we are able to palliate their symptoms,” he said in an interview with The Oncology Nurse. “Our findings are good news, and we were happy that we did not have similar toxicities as have been seen in treating similar patients.”
Although FNRT can help with many types of cancer, it reportedly works best on lung cancer, sarcomas, glioblastomas, prostate cancer, and head and neck cancers. In the FNRT study for salvage therapy, Konski and his colleagues studied the outcomes of 20 patients with NSCLC who had failed primary treatment with chemotherapy and/or radiotherapy. The estimated clinical relative biological effectiveness for neutron radiotherapy was found to be three times greater than photon radiotherapy in the normal lung tissue and four times more effective for targeted tumors. In the study group, there were no grade 3 or 4 toxicities. All treatment-related toxicities, such as radiation pneumonitis, esophagitis, and radiation dermatitis, were adequately treated on an outpatient basis.
Among the 12 patients who had longer than a 1-month follow-up, six patients had no evidence of local cancer progression. The median local control of the other six patients was 3 months. Nine of 14 symptomatic patients had successful palliation within 1 month after treatment was completed. The 1-year survival rate was 20%, and 1-year disease-free survival was 10%.
For the study of FNRT for advanced stage NSCLC, the researchers looked at the results in 23 patients who received a combination of FNRT and photon radiotherapy between March 1993 and December 2006. The median follow-up was 5 months. No grade 4 toxicities were recorded; however, three patients developed grade 3 radiation pneumonitis. A total of 12 patients developed grade 1 or 2 esophagitis and nine patients developed grade 1 radiation dermatitis. One patient had grade 3 radiation dermatitis.
Among the 20 patients who had longer than 1-month follow-up, 16 had no evidence of local progression, and the median local control of the other four who did have recurrence was 3 months. The median overall survival was 7 months, and the median disease-free survival was almost 3 months. One-year overall survival was 32.4%, and 1-year disease-free survival was 5.3%.
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