XXXX and patterns of failure of adaptive/ablative proton therapy for early-stage, medically inoperable @entity1149 .

@entity1 @entity137 @entity55 @entity5 @entity2910 @entity1149 @entity1295 @entity299 @entity158 @entity3 @entity1909
PURPOSE: To analyze the @entity137 and patterns of failure of proton therapy given in ablative doses for medically inoperable early-stage @entity1149 ( @entity1149 ). METHODS AND MATERIALS: Eighteen @entity1 with medically inoperable T1N0M0 (central location) or T2-3N0M0 (any location) @entity1149 were treated with proton therapy at 87.5 Gy (relative biological effectiveness) at 2.5 Gy /fraction in this Phase I/II study. All @entity1 underwent treatment simulation with four-dimensional CT; internal gross @entity5 volumes were delineated on maximal intensity projection images and modified by visual verification of the target volume in 10 breathing phases. The internal gross @entity5 volumes with maximal intensity projection density was used to design compensators and apertures to account for @entity5 motion. Therapy consisted of passively scattered protons. All @entity1 underwent repeat four-dimensional CT simulations during treatment to assess the need for adaptive replanning. RESULTS: At a median follow-up time of 16.3 months (range, 4.8-36.3 months), no @entity1 had experienced Grade 4 or 5 @entity137 . The most common adverse effect was @entity1909 (Grade 2, 67%; Grade 3, 17%), followed by Grade 2 @entity1295 (44%), Grade 2 @entity55 (11%), Grade 2 @entity2910 (6%), and Grade 2 chest wall @entity158 (6%). Rates of local control were 88.9%, regional lymph node failure 11.1%, and distant metastasis 27.8%. Twelve @entity1 (67%) were still alive at the last follow-up; five had died of @entity3 and one of preexisting @entity299 . CONCLUSIONS: Proton therapy to ablative doses is well tolerated and produces promising local control rates for medically inoperable early-stage @entity1149 .
