Qiu Bin, Men Yu, Wang Junjie, Hui Zhouguang
Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China.
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Cancers (Basel). 2021 Sep 10;13(18):4545. doi: 10.3390/cancers13184545.
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.
非小细胞肺癌（NSCLC）是最常见的恶性肿瘤，放射治疗（RT）是其多模态治疗的重要组成部分。随着新型放疗技术的出现，接受放疗的NSCLC患者的临床结局得到了显著改善。质子治疗的出现，与光子治疗相比，其剂量增加和下降更陡峭，有可能改善NSCLC的临床结局。剂量学研究表明，与光子治疗相比，质子治疗可以显著降低正常器官的剂量，尤其是肺、心脏和食管的剂量，同时在早期和晚期NSCLC中保持相似的靶区体积覆盖。然而，迄今为止，大多数研究都是单臂研究，得出质子治疗与立体定向体部放疗（SBRT）相比，早期NSCLC的疗效没有显著变化的结论。这些研究中质子治疗晚期NSCLC的结果很有前景，与既往光子治疗数据相比，临床结局得到改善，毒性降低。然而，这些研究也主要是单臂研究，缺乏两种治疗方法之间的直接比较。目前，有许多新出现的证据聚焦于已发表的NSCLC质子治疗的剂量学、疗效、安全性和成本效益，然而，迄今为止，缺乏对这些治疗方法进行比较的全面综述。因此，本综述聚焦于NSCLC质子治疗的这些方面。
