Thoracic Malignancies: Proton Beam and Carbon-ion Therapy for Thoracic Cancers and Recurrent Disease

Thoracic malignancies represent a heterogeneous spectrum of primary cancers and metastatic disease. Radiation plays an essential role in management, as local ablation and cytoreduction of disease are directly associated with improved outcomes. Over the past decade, therapeutic advancements have led to a growing population of long-term survivors as well as an increasing number of patients susceptible to treatment-related toxicities. As such, novel strategies to further optimize the therapeutic ratio remain an active area of research. Particle therapy has correspondingly emerged as an exciting treatment strategy for many thoracic cancers, exemplified by dosimetric and clinical advantages over photon radiotherapy. This chapter discusses the evolving indications and rationale for utilizing particle therapy among this unique patient population. Following a comprehensive review of the clinical data, we discuss patient selection and safety considerations, technical challenges, and economic and operational factors as a practical guide for clinicians. We then close by exploring future directions currently under investigation. Taken together, this focused examination highlights the promise of particle therapy for improving thoracic patient outcomes and further expanding the field.