Prospective Particle Therapy Trials for Locally Advanced Lung Cancer

Efforts to increase tumor control and minimize toxic effects to normal tissue have been long-sought goals in the treatment of patients with locally advanced solid tumors who receive multimodal therapeutic approaches. For patients with non–small-cell lung cancer with clinically unresectable stage II to III disease, one standard of care for patients with a reasonable performance status is consideration of concomitant chemoradiotherapy, often with a platinum doublet and standard fractionation external-beam radiotherapy using conventional x-rays (photon energy). To minimize radiation-induced toxic effects to vital organs-at-risk in the thorax, such as the spinal cord, esophagus, lung parenchyma, bronchus, heart, and substructures, conformal radiotherapy approaches have been developed over the past 2 decades. Particle therapy can lessen the delivered integral dose, and the relatively steeper dose gradient compared with conventional x-rays can lead to superior conformality and potentially fewer toxic effects to normal tissue. However, well-designed, prospective clinical trials have lagged as the number of proton centers has increased. This is unfortunate and has delayed the generation of crucial evidence-based recommendations for use of this component of the anticancer toolbox.

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