{"doi":"10.3389/fonc.2022.1074675","title":"Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era","abstract":"Introduction: As immunotherapy has improved distant metastasis-free survival (DMFS) in Non-Small Cell Lung Cancer (NSCLC), isolated locoregional recurrences have increased. However, management of locoregional recurrences can be challenging. We report our institutional experience with definitive intent re-irradiation using Intensity Modulated Proton Therapy (IMPT). Method: Retrospective cohort study of recurrent or second primary NSCLC or LS-SCLC treated with IMPT. Kaplan-Meier method and log-rank test were used for time-to-event analyses. Results: 22 patients were treated from 2019 to 2021. After first course of radiation (median 60 Gy, range 45-70 Gy), 45% received adjuvant immunotherapy. IMPT re-irradiation began a median of 28.2 months (8.8-172.9 months) after initial radiotherapy. The median IMPT dose was 60 GyE (44-60 GyE). 36% received concurrent chemotherapy with IMPT and 18% received immunotherapy after IMPT. The median patient's IMPT lung mean dose was 5.3 GyE (0.9-13.9 GyE) and 5 patients had cumulative esophagus max dose >100 GyE with 1-year overall survival (OS) 68%, 1-year local control 80%, 1-year progression free survival 45%, and 1-year DMFS 60%. Higher IMPT (HR 1.4; 95% CI 1.1-1.7, p=0.01) and initial radiotherapy mean lung doses (HR 1.3; 95% CI 1.0-1.6, p=0.04) were associated with worse OS. Two patients developed Grade 3 pneumonitis or dermatitis, one patient developed Grade 2 pneumonitis, and seven patients developed Grade 1 toxicity. There were no Grade 4 or 5 toxicities. Discussion: Definitive IMPT re-irradiation for lung cancer can prolong disease control with limited toxicity, particularly in the immunotherapy era.","journal":"Frontiers in Oncology","year":2023,"id":358920,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":10,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9533,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":941124,"name":"Yichun Cao","orcid":"0009-0004-6001-855X","position":1,"is_corresponding":false},{"id":787983,"name":"Neal S. McCall","orcid":"0000-0001-7571-6984","position":2,"is_corresponding":false},{"id":305854,"name":"Jeffrey M. Switchenko","orcid":"0000-0002-5563-9325","position":3,"is_corresponding":false},{"id":426285,"name":"Sibo Tian","orcid":"0000-0001-5018-4854","position":4,"is_corresponding":false},{"id":1109270,"name":"Haijian Chen","orcid":"0009-0008-0357-9632","position":5,"is_corresponding":false},{"id":898467,"name":"William Stokes","orcid":"0000-0002-8684-0494","position":6,"is_corresponding":false},{"id":250449,"name":"Aparna H. Kesarwala","orcid":"0000-0001-8297-9643","position":7,"is_corresponding":false},{"id":413774,"name":"Mark W. McDonald","orcid":"0000-0003-3021-9356","position":8,"is_corresponding":false},{"id":413773,"name":"Joseph W. Shelton","orcid":"0000-0003-0426-8197","position":9,"is_corresponding":false},{"id":554291,"name":"Jeffrey D. Bradley","orcid":"0000-0001-9305-7396","position":10,"is_corresponding":false},{"id":267372,"name":"Kristin Higgins","orcid":"0000-0003-1496-9878","position":11,"is_corresponding":false},{"id":421856,"name":"James Janopaul‐Naylor","orcid":"0000-0002-3612-4852","position":0,"is_corresponding":true}],"reference_count":60,"raw_metadata":null,"created_at":"2026-07-19T01:13:48.379546Z","pmid":"36733369","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}