Particle therapy in lung cancer: where do we stand?
BACKGROUND
From a theoretical point of view, charged particles should lead to superior results compared to photons. In this review, we searched for clinical evidence that protons or C-ions are really beneficial to patients with lung cancer.


METHODS
A systematic literature review based on an earlier published comprehensive review was performed and updated until November 1st 2007.


RESULTS
Ten fully published series, all dealing with non-small cell lung cancer (NSCLC), mainly stage I, were identified. No phase III trials were found. On proton therapy, 2-5 year local tumor control rates varied between 87% and 57%. The 2 year/5 year overall survival and 2 year/5 year cause specific survival varied between 31-74%/23% and 58-86%/46%, respectively. Late side effects were observed in about 10% of the patients. For C-ion therapy, the local tumor control rate was 77%, while 95% when using a hypofractionated radiation schedule. The 5 year overall survival and cause specific survival rates were 42% and 60%, respectively. Slightly better results were reported when using hypofractionation, 50% and 76%, respectively. The reported late side effects for C-ions were 4%.


CONCLUSIONS
The results with charged particles, at least for stage I disease, seem to be promising. A gain can be expected in reduction of late side effects, especially after treatment with C-ions. Available data demonstrate that particle therapy in general is a safe and feasible treatment modality. Although current results are promising, more evidence is required before particle therapy can become internationally the standard treatment for (subsets of) lung cancer patients.
Pijls-Johannesma
Madelon
M
Maastricht Radiation Oncology (MAASTRO clinic), Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands. madelon.pijls@maastro.nl
Grutters
Janneke P C
JP
Lambin
Philippe
P
Ruysscher
Dirk De
DD
D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D002986:Clinical Trials as Topic; D004601:Elementary Particles / Q000009:adverse effects / Q000627:therapeutic use*; D063193:Heavy Ion Radiotherapy; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D011379:Prognosis; D061766:Proton Therapy; D015996:Survival Rate; D011522:Protons
D011522:Protons