Consensus statement of proton therapy in early stage and locally advanced non–small cell lung cancer

Publication date: Available online 23 January 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Joe Y. Chang, Salma K. Jabbour, Dirk De Ruysscher, Steven E. Schild, Charles B. Simone, Ramesh Rengan, Steven Feigenberg, Atif J. Khan, Noah C. Choi, Jeffrey D. Bradley, Xiaorong R. Zhu, Antony J. Lomax, Bradford S. Hoppe
Radiation dose escalation has been shown to improve local control and survival in non–small cell lung cancer (NSCLC) patients in some studies but randomized data has not supported this premise, possibly due to adverse effects. Because of the physical characteristics of the Bragg peak, proton therapy (PT) delivers minimal exit dose distal to the target volume resulting in better sparing of normal tissues in comparison to photon based radiotherapy. This is particularly important for lung cancer due to the proximity of lung, heart, esophagus, major airways, large blood vessels and spinal cord. However, PT is associated with more uncertainty due to finite range of proton beam and motion for thoracic cancers. PT is more costly than traditional photon therapy but may reduce side effects and toxicity-related hospitalization which has its own associated cost. The cost of PT is decreasing over time due to reduced prices for the building, machine, maintenance, overhead and newer, shorter treatment programs. PT is improving rapidly as more research is performed particularly with the implementation of 4-dimensional CT based motion management and intensity-modulated proton therapy (IMPT). Due to these controversies, there is much debate in the oncology community about which lung cancer patients benefit significantly from proton therapy. The PTCOG thoracic subcommittee task group intends to address the issues of proton therapy indications, advantages/limitations, cost effectiveness, technology improvement, clinical trials and future research directions. This consensus report can be used to guide clinical practice and indications for proton therapy, insurance approval, and clinical/translational research directions.



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