Does Proton Therapy Offer Demonstrable Clinical Advantages for Treating Thoracic Tumors?

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

The finite range of proton beams in tissues offers unique dosimetric advantages that theoretically allow dose to the target to be escalated while minimizing exposure of surrounding tissues and thus minimizing radiation-induced toxicity. This theoretical advantage has led to widespread adoption of proton therapy around the world for a wide variety of tumors at different anatomical sites. Many treatment-planning comparisons have shown that proton therapy has substantial dosimetric advantages over conventional radiotherapy. However, given the significant difference in cost for proton vs conventional photon therapy, thorough investigation of the evidence of proton therapy's clinical benefits in terms of toxicity and survival is warranted. Some data from retrospective studies, single-arm prospective studies, and a very few randomized clinical trials comparing these modalities are beginning to emerge. In this review, we examine the available data with regard to proton therapy for thoracic malignancies. We begin by discussing the unique challenges involved in treating moving targets with significant tissue heterogeneity and the technologic efforts underway to overcome these challenges. We then discuss the rationale for minimizing normal tissue toxicity, particularly pulmonary, cardiac, and hematologic toxicity, within the context of previously unsuccessful attempts at dose escalation for lung and esophageal cancer. Finally, we explore strategies for accelerating the development of trials aimed at measuring meaningful clinical endpoints and for maximizing the value of proton therapy by personalizing its use for individual patients.

Original languageEnglish (US)
Pages (from-to)114-124
Number of pages11
JournalSeminars in Radiation Oncology
Volume28
Issue number2
DOIs
StatePublished - Apr 1 2018

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Proton Therapy
Thorax
Neoplasms
Protons
Esophageal Neoplasms
Photons
Lung Neoplasms
Radiotherapy
Randomized Controlled Trials
Retrospective Studies
Prospective Studies
Radiation
Costs and Cost Analysis
Lung
Survival
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Does Proton Therapy Offer Demonstrable Clinical Advantages for Treating Thoracic Tumors? / Liao, Zhongxing; Gandhi, Saumil; Lin, Steven Hsesheng; Bradley, Jeffrey.

In: Seminars in Radiation Oncology, Vol. 28, No. 2, 01.04.2018, p. 114-124.

Research output: Contribution to journalReview article

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