Carbon-ion radiotherapy for patients with advanced stage non-small-cell lung cancer at multicenters

Carbon-ion radiation therapy (CIRT) for advanced non–small-cell lung cancer (NSCLC) has not been wellstudied to date. This paper aimed to analyze a retrospective multicenter survey for detecting problems with theuse of CIRT for Stage II and III NSCLC (7th UICC TNM Staging System). Inclusion was restricted to patientswith Stage II and III NSCLC who received CIRT from November 2003 to December 2014. We gathered thedata from three CIRT operating centers on July 2015. Patients with radiotherapy history, patients with cancersother than lung cancer, and those receiving palliative therapies were excluded. The patient characteristics, prescribeddose/fraction, survival rates, and adverse effects were analyzed. The total number of patients was 64(male: 49, female: 15). Of these, 53 patients were medically inoperable. The median age was 76 years (range46–91), and the median follow-up period was 18.5 months (range 3.2–121.5). The clinical staging consisted of10 Stage IIA, 30 Stage IIB, 23 Stage IIIA and 1 Stage IIIB. The median prescribed dose was 72.0 Gy (RBE)(range 52.8–72.0) in 16 fractions (range 4–16). The 2-year overall survival, progression-free survival, and local controlrates were 62.2% [confidence interval (CI): 47.5–76.9], 42.3% (CI: 28.8–55.8) and 81.8% (CI: 69.9–94.0),respectively. There were no higher than Grade 2 adverse effects observed. CIRT for inoperable Stage II and IIINSCLC could be implemented without severe adverse effects, but the clinical staging (including lymph node status)was inhomogeneous. In addition, the prescribed dose and fractionation were not standardized. Further data accumulationand a multiple centers prospective trial for evaluating clinical stage–based results are required