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Int J Radiat Oncol Biol Phys. 2016 May 1;95(1):505-16. doi: 10.1016/j.ijrobp.2016.01.036. Epub 2016 Jan 23.

Consensus Statement on Proton Therapy in Early-Stage and Locally Advanced Non-Small Cell Lung Cancer.

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Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address:
Rutgers Cancer Institute of New Jersey Rutgers, Robert Wood Johnson Medical School, The State University of New Jersey, New Brunswick, New Jersey.
MAASTRO Clinic, Maastricht, Netherlands.
Mayo Clinic, Scottsdale, Arizona.
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
University of Washington Medical Center, Seattle, Washington.
University of Maryland Medical Center, Baltimore, Maryland.
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Washington University, St Louis, Missouri.
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Paul Scherrer Institute, Villigen, Switzerland.
University of Florida Proton Therapy Institute, Jacksonville, Florida.


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.

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