Executive summary

This review article by the group in Beijng, China examined the available data of dosimetry and clinical outcomes of PBT for NSCLC. The review found from retrospective dosimetric studies that proton therapy, both PSPT and PBS, have an advantage compared with photon therapy, both for early-stage or advanced NSCLC, presenting favorable or comparable CTV coverage with more homogenous dose distribution and more normal tissue sparing. However, the clinical outcomes of proton therapy varied among studies. In the early-stage NSCLC setting, all of the studies had a small sample size and were single-arm without direct comparison; the comparison being based on historical data. The conclusion regarding the efficacy and safety of proton therapy over photon therapy should be further explored in prospective comparative studies. Proton therapy was promising for locally advanced NSCLC with improved clinical outcomes and reduced toxicity when compared with historical photon therapy data, with lower rates of severe (grade 3) toxicities, although the only RCT reported grade ≥ 3 radiation pneumonitis rate of IMRT, 6.5% versus PSPT, 10.5%. Further study of PBS is ongoing and direct comparison is warranted.




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