This review article examined clinical outcomes data of IMRT and PBT for locally advanced NSCLC. This review pointed out that PBT is not considered the standard of care for locally advanced NSCLC, likely because of the limited comparative data to IMRT, increased cost, and added technical considerations. However, dosimetric data suggests both PS-PT and IMPT can better spare certain OARs than IMRT, with IMPT providing the greatest dosimetric benefit but potentially requiring additional adjustments for uncertainties associated with beam range and organ motion.

Given the increasing recognition of the importance of heart dose for NSCLC, proton therapy may provide a benefit over IMRT for certain anatomically challenging tumors on a case-by-case basis. Proton therapy may help achieve safer dose escalation, and re-irradiation with proton therapy appears feasible for carefully selected patients.