Dosimetry, Efficacy, Safety, and Cost-Effectiveness of Proton Therapy for Non-Small Cell Lung Cancer

SIMPLE SUMMARY: Non-small cell lung cancer (NSCLC) is the most common malignancy requiring radiotherapy (RT) as an important part of its multimodality treatment, the emergence of proton therapy may further allow for a sharper dose of build-up and drop-off com-pared to photon therapy, which has potentially improved clinical outcomes of NSCLC. Currently, there has been much emerging evidence focusing on dosimetry, efficacy, safety, and cost-effectiveness of proton therapy for non-small cell lung cancer (NSCLC) published, however, a comprehensive review comparing these therapies is, to date, lacking. This review focuses on these aspects of dosimetry, efficacy, safety, and cost-effectiveness of proton therapy for NSCLC. ABSTRACT: Non-small cell lung cancer (NSCLC) is the most common malignancy which requires radiotherapy (RT) as an important part of its multimodality treatment. With the advent of the novel irradiation technique, the clinical outcome of NSCLC patients who receive RT has been dramatically improved. The emergence of proton therapy, which allows for a sharper dose of build-up and drop-off compared to photon therapy, has potentially improved clinical outcomes of NSCLC. Dosimetry studies have indicated that proton therapy can significantly reduce the doses for normal organs, especially the lung, heart, and esophagus while maintaining similar robust target volume coverage in both early and advanced NSCLC compared with photon therapy. However, to date, most studies have been single-arm and concluded no significant changes in the efficacy for early-stage NSCLC by proton therapy over stereotactic body radiation therapy (SBRT). The results of proton therapy for advanced NSCLC in these studies were promising, with improved clinical outcomes and reduced toxicities compared with historical photon therapy data. However, these studies were also mainly single-arm and lacked a direct comparison between the two therapies. Currently, there is much emerging evidence focusing on dosimetry, efficacy, safety, and cost-effectiveness of proton therapy for NSCLC that has been published, however, a comprehensive review comparing these therapies is, to date, lacking. Thus, this review focuses on these aspects of proton therapy for NSCLC.