Proton Therapy for Lung Tumors
Reduced Radiation to Surrounding Healthy Tissues
Excess radiation dose to the lungs and heart during treatment for locally advanced non-small cell lung cancer has been prospectively associated with increased risk of severe pulmonary toxicity and decreased overall survival, respectively.
However, proton therapy has been shown in multiple studies to reduce radiation exposure to normal surrounding structures—including the heart, lungs, esophagus, and spinal cord—as compared to standard and even advanced forms of photon-based therapy.[2-5] Based upon a growing body of evidence, proton therapy is currently indicated for patients with the following:
Early stage non-small cell lung cancer (ES-NSCLC)
- Excellent long-term oncologic outcomes [6,7]
- Impressive reduction in significant side effects [6-7]
- Potentially beneficial for large or otherwise anatomically challenging lung cancers 
Locally advanced non-small cell lung cancer (LA-NSCLC)
Proton beam therapy with concurrent chemotherapy for definitive treatment
- Excellent clinical outcomes [9-13]
- Very low rates of lung and esophagus toxicity even when treated with higher doses of radiation [9-13]
Adjuvant proton beam radiation following surgery and/or chemotherapy:
- Initial report of excellent oncologic outcomes and very low rates of serious treatment-related side effects 
Proton beam therapy for recurrent thoracic tumors
- Good local control of disease while minimizing serious treatment-related toxicities in patients with a recurrent tumor in previously irradiated site following high initial courses of radiation [15,16]
1. Chun, S.G., et al., Impact of Intensity-Modulated Radiation Therapy Technique for Locally Advanced Non-Small-Cell Lung Cancer: A Secondary Analysis of the NRG Oncology RTOG 0617 Randomized Clinical Trial. J Clin Oncol, 2017. 35(1): p. 56-62.
2. Chang, J.Y., et al., Significant reduction of normal tissue dose by proton radiotherapy compared with three-dimensional conformal or intensity-modulated radiation therapy in Stage I or Stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 2006. 65(4): p. 1087-96.
3. Ohno, T., et al., Comparison of dose-volume histograms between proton beam and X-ray conformal radiotherapy for locally advanced non-small-cell lung cancer. J Radiat Res, 2015. 56(1): p. 128-33.
4. Wu, C.T., et al., Dosimetric comparison between proton beam therapy and photon radiation therapy for locally advanced non-small cell lung cancer. Jpn J Clin Oncol, 2016.
5. Zhang, X., et al., Intensity-modulated proton therapy reduces the dose to normal tissue compared with intensity-modulated radiation therapy or passive scattering proton therapy and enables individualized radical radiotherapy for extensive stage IIIB non-small-cell lung cancer: a virtual clinical study. Int J Radiat Oncol Biol Phys, 2010. 77(2): p. 357-66.
6. Bush, D.A., et al., High-dose hypofractionated proton beam radiation therapy is safe and effective for central and peripheral early-stage non-small cell lung cancer: results of a 12-year experience at Loma Linda University Medical Center. Int J Radiat Oncol Biol Phys, 2013. 86(5): p. 964-8.
7. Makita, C., et al., High-dose proton beam therapy for stage I non-small cell lung cancer: Clinical outcomes and prognostic factors. Acta Oncol, 2015. 54(3): p. 307-14.
8. Chang, J.Y., et al., Consensus Statement on Proton Therapy in Early-Stage and Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys, 2016. 95(1): p. 505-16.
9. Chang, J.Y., et al., Phase 2 study of high-dose proton therapy with concurrent chemotherapy for unresectable stage III nonsmall cell lung cancer. Cancer, 2011. 117(20): p. 4707-13.
10. Chang, J.Y., et al., Long-term outcome of phase I/II prospective study of dose-escalated proton therapy for early-stage non-small cell lung cancer. Radiother Oncol, 2017. 122(2): p. 274-280.
11. Hoppe, B.S., et al., A Phase 2 Trial of Concurrent Chemotherapy and Proton Therapy for Stage III Non-Small Cell Lung Cancer: Results and Reflections Following Early Closure of a Single-Institution Study. Int J Radiat Oncol Biol Phys, 2016. 95(1): p. 517-22.
12. Nguyen, Q.N., et al., Long-term outcomes after proton therapy, with concurrent chemotherapy, for stage II-III inoperable non-small cell lung cancer. Radiother Oncol, 2015. 115(3): p. 367-72.
13. Oshiro, Y., et al., High-dose concurrent chemo-proton therapy for Stage III NSCLC: preliminary results of a Phase II study. J Radiat Res, 2014. 55(5): p. 959-65.
14. Remick, J.S., et al., First Clinical Report of Proton Beam Therapy for Postoperative Radiotherapy for Non-Small-Cell Lung Cancer. Clin Lung Cancer, 2017. 18(4): p. 364-371.
15. Ho, J.C., et al., Reirradiation of Thoracic Cancers with Intensity Modulated Proton Therapy. Int J Radiat Oncol Biol Phys, 2017. 98(1): p. 222.
16. McAvoy, S., et al., Definitive reirradiation for locoregionally recurrent non-small cell lung cancer with proton beam therapy or intensity modulated radiation therapy: predictors of high-grade toxicity and survival outcomes. Int J Radiat Oncol Biol Phys, 2014. 90(4): p. 819-27.