Proton beam radiotherapy for patients with early-stage and advanced lung cancer: A narrative review with contemporary clinical recommendations

Jennifer S. Chiang, Nathan Y. Yu, Thomas B. Daniels, Wei Liu, Steven E. Schild, Terence T. Sio

Research output: Contribution to journalReview articlepeer-review

Abstract

Although lung cancer rates are decreasing nationally, lung cancer remains the leading cause of cancer related death. Despite advancements in treatment and technology, overall survival (OS) for lung cancer remains poor. Proton beam therapy (PBT) is an advanced radiation therapy (RT) modality for treatment of lung cancer with the potential to achieve dose escalation to tumor while sparing critical structures due to higher target conformality. In early and late-stage non-small cell lung cancer (NSCLC), dosimetric studies demonstrated reduced doses to organs at risk (OARs) such as the lung, spinal cord, and heart, and clinical studies report limited toxicities with PBT, including hypofractionated regimens. In limited-stage SCLC, studies showed that regimens chemo RT including PBT were well tolerated, which may help optimize clinical outcomes. Improved toxicity profiles may be beneficial in post-operative radiotherapy, for which initial dosimetric and clinical data are encouraging. Sparing of OARs may also increase the proportion of patients able to complete reirradiation for recurrent disease. However, there are various challenges of using PBT including a higher financial burden on healthcare and limited data supporting its cost-effectiveness. Further studies are needed to identify subgroups that benefit from PBT based on prognostic factors, and to evaluate PBT combined with immunotherapy, in order to elucidate the benefit that PBT may offer future lung cancer patients.

Original languageEnglish (US)
Pages (from-to)1270-1285
Number of pages16
JournalJournal of Thoracic Disease
Volume13
Issue number2
DOIs
StatePublished - Feb 2021

Keywords

  • Non-small cell lung cancer (NSCLC)
  • Proton beam therapy (PBT)
  • Small cell lung cancer (SCLC)

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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