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Proton Therapy for the Treatment of Locally Advanced NSCLC
At the 23rd Annual Perspectives in Thoracic Oncology meeting, Abigail Berman, MD, MSCE, Assistant Professor, Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, discussed the use of proton therapy for locally advanced NSCLC.
Transcript
When I think about the use of proton therapy in locally advanced non-small cell lung cancer, I really think that there's probably an advantage for most patients. As I discussed today in my lecture, it's not just the decreased dose to the lung that I think is the advantage. Probably the biggest advantage is the decreased dose to the heart.
We have increasing data that demonstrates that heart dose corresponds to risk of cardiac events. Cardiac events corresponds with overall survival. Therefore, heart dose is increasingly, in our minds, becoming critically important. That dose can be minimized with proton therapy.
Having said that, there are specific patient circumstances that lend themselves particularly well to proton therapy. One is large tumors, large nodal disease, specifically tumors or nodal disease that is right up against the heart, where we really need to be worried about that heart dose.
Large tumors where we wouldn't even be able to meet lung constraints if we were treating with standard photon radiation. In addition, patients who have underlying cardiac disease or, for that matter, underlying lung disease where we need to minimize that dose as much as we possibly can.
By the same token, young patients who are otherwise healthy, you can certainly argue will also benefit very much from proton radiation because their underlying potential for heart disease in years to come is increased.
In addition, we have to realize that patients are living longer and longer. Hopefully, the benefit of proton therapy, which is a decrease in long-term toxicity, will be realized more and more as our cure rates, our PFS, and our OS are going up, especially with the combination of immunotherapy into the picture.
