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Heavy Particles in Non-small Cell Lung Cancer: Protons

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Advances in Radiation Oncology in Lung Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

Radiation therapy is a primary treatment modality for a variety of presentations of lung cancer, but thoracic radiotherapy can be associated with significant morbidities. Due to its unique physical properties, proton therapy can allow for significant dosimetric advantage for patients with lung cancer, reducing unnecessary irradiation doses to critical thoracic structures such as the lungs, esophagus, and heart while optimizing dose to the intended tumor volume. Compared with traditional photon therapy, the dose reductions to normal tissues achievable with proton therapy in select patients can achieve significantly fewer high-grade toxicities, more safely deliver dose escalation, more adequately treat bulky tumors adjacent to critical structures, improve the therapeutic ratio of trimodality therapy, and offer a new chance of cure following locoregional recurrence after prior radiotherapy. Passively scattered and pencil beam scanning proton therapy are discussed, with pencil beam scanning affording greater dose conformality and potentially superior clinical outcomes. Proton therapy has an increasingly well-demonstrated role in the treatment of both early-stage and locally advanced non-small cell lung cancer that is detailed in this chapter. Proton therapy also has emerging roles for other thoracic malignancies, including small cell lung cancer, esophageal cancer, thymic tumors, malignant pleural mesothelioma, and cardiac malignancies. Prospective randomized evidence is emerging supporting its use as a standard treatment to optimize thoracic radiotherapy.

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  1. New York Proton Center, New York, NY, USA

    Charles B. Simone II

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    Branislav Jeremić

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Simone, C.B. (2022). Heavy Particles in Non-small Cell Lung Cancer: Protons. In: Jeremić, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2022_341

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