title: Consensus Statement on Proton Therapy in Early-Stage and Locally Advanced Non-Small Cell Lung Cancer.
abstract: Radiation dose escalation has been shown to improve local control and survival in patients with non-small cell lung cancer in some studies, but randomized data have not supported this premise, possibly owing to adverse effects. Because of the physical characteristics of the Bragg peak, proton therapy (PT) delivers minimal exit dose distal to the target volume, resulting in better sparing of normal tissues in comparison to photon-based radiation therapy. This is particularly important for lung cancer given the proximity of the lung, heart, esophagus, major airways, large blood vessels, and spinal cord. However, PT is associated with more uncertainty because of the finite range of the proton beam and motion for thoracic cancers. PT is more costly than traditional photon therapy but may reduce side effects and toxicity-related hospitalization, which has its own associated cost. The cost of PT is decreasing over time because of reduced prices for the building, machine, maintenance, and overhead, as well as newer, shorter treatment programs. PT is improving rapidly as more research is performed particularly with the implementation of 4-dimensional computed tomography-based motion management and intensity modulated PT. Given these controversies, there is much debate in the oncology community about which patients with lung cancer benefit significantly from PT. The Particle Therapy Co-operative Group (PTCOG) Thoracic Subcommittee task group intends to address the issues of PT indications, advantages and limitations, cost-effectiveness, technology improvement, clinical trials, and future research directions. This consensus report can be used to guide clinical practice and indications for PT, insurance approval, and clinical or translational research directions.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: jychang@mdanderson.org.
authors.forename: Joe Y
authors.initials: JY
authors.lastname: Chang
authors.affiliation: Rutgers Cancer Institute of New Jersey Rutgers, Robert Wood Johnson Medical School, The State University of New Jersey, New Brunswick, New Jersey.
authors.forename: Salma K
authors.initials: SK
authors.lastname: Jabbour
authors.affiliation: MAASTRO Clinic, Maastricht, Netherlands.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ruysscher
authors.affiliation: Mayo Clinic, Scottsdale, Arizona.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Simone
authors.affiliation: University of Washington Medical Center, Seattle, Washington.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Rengan
authors.affiliation: University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Steven
authors.initials: S
authors.lastname: Feigenberg
authors.affiliation: Rutgers Cancer Institute of New Jersey Rutgers, Robert Wood Johnson Medical School, The State University of New Jersey, New Brunswick, New Jersey.
authors.forename: Atif J
authors.initials: AJ
authors.lastname: Khan
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Noah C
authors.initials: NC
authors.lastname: Choi
authors.affiliation: Washington University, St Louis, Missouri.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bradley
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Xiaorong R
authors.initials: XR
authors.lastname: Zhu
authors.affiliation: Paul Scherrer Institute, Villigen, Switzerland.
authors.forename: Antony J
authors.initials: AJ
authors.lastname: Lomax
authors.affiliation: University of Florida Proton Therapy Institute, Jacksonville, Florida.
authors.forename: Bradford S
authors.initials: BS
authors.lastname: Hoppe
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D002986:Clinical Trials as Topic; D032921:Consensus; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009068:Movement; D059351:Organ Sparing Treatments; D058958:Organs at Risk / Q000528:radiation effects; D061766:Proton Therapy / Q000191:economics / Q000379:methods*; D011832:Radiation Injuries / Q000517:prevention & control; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012542:Scattering, Radiation; D047368:Tumor Burden