Where are we with proton beam therapy for thoracic malignancies? Current status and future perspectives

Stanislav Lazarev, Kenneth Rosenzweig, Robert Samstein, Lucas Resende Salgado, Shaakir Hasan, Robert H. Press, Sonam Sharma, Charles A. Powell, Fred R. Hirsch, Charles B. Simone

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Radiation therapy (RT) plays an important role in the curative treatment of a variety of thoracic malignancies. However, delivery of tumoricidal doses with conventional photon-based RT to thoracic tumors often presents unique challenges. Extraneous dose deposited along the entrance and exit paths of the photon beam increases the likelihood of significant acute and delayed toxicities in cardiac, pulmonary, and gastrointestinal structures. Furthermore, safe dose-escalation, delivery of concomitant systemic therapy, or reirradiation of a recurrent disease are frequently not feasible with photon RT. In contrast, protons have distinct physical properties that allow them to deposit a high irradiation dose in the target, while leaving a negligible exit dose in the adjacent organs at risk. Proton beam therapy (PBT), therefore, can reduce toxicities with similar antitumor effect or allow for dose escalation and enhanced antitumor effect with the same or even lower risk of adverse events, thus potentially improving the therapeutic ratio of the treatment. For thoracic malignancies, this favorable dose distribution can translate to decreases in treatment-related morbidities, provide more durable disease control, and potentially prolong survival. This review examines the evolving role of PBT in the treatment of thoracic malignancies and evaluates the data supporting its use.

Original languageEnglish
Pages (from-to)157-164
Number of pages8
JournalLung Cancer
StatePublished - Feb 2021


  • Lung cancer
  • Mesothelioma
  • Proton therapy
  • Thymic
  • Toxicities
  • Tumors


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