Abstract
Particle, essentially, proton radiotherapy (RT) could provide some benefits over photon RT, especially in reducing the side effects of RT. We performed a systematic review to identify the performed randomised clinical trials (RCTs) and ongoing RCTs comparing particle RT with photon therapy. So far, there are no results available from phase 3 RCTs comparing particle RT with photon therapy. Furthermore, the results on side effects comparing proton and carbon ion beam RT with photon RT do vary. The introduction of new techniques in photon RT, such as image-guided RT (IGRT), intensity-modulated RT (IMRT), volumetric arc therapy (VMAT) and stereotactic body RT (SBRT) was already effective in reducing side effects. At present, the lack of evidence limits the indications for proton and carbon ion beam RTs and makes the particle RT still experimental.
Highlights
Radiotherapy (RT) after surgery is the second main treatment in solid tumours and far in front of systemic treatment [1]
The preliminary results of a study in non-small cell lung cancer with underlying idiopathic pulmonary fibrosis showed a tendency of non-statistically significant better survival compared to X-ray (p = 0.08) for patients treated with proton therapy, especially in subgroups of GAP stages II and III at Samsung Medical Center in Korea [8]
Proton RT was associated with improved survival, which may be driven by decreased incidence of post-treatment liver decompensation [Adjusted hazard ratio (AHR) = 0.47 (95%CI 0.27–0.82)] [9]
Summary
Radiotherapy (RT) after surgery is the second main treatment in solid tumours and far in front of systemic treatment [1]. In the continuous process for improvement, it was suggested that proton therapy, due to its Bragg peak, and carbon ions, due to the Bragg peak and to a higher radiobiologic effect (RBE), could have a promising future and become the best practice in radiotherapy. The Ludwig Boltzmann Institute published a recent systematic review for carbon ion beam RT [6]. They concluded that ‘carbon ion beam RT (CIRT) can be described as a potentially less invasive cancer treatment due to its physical properties. Due to the lack of controlled trials, no conclusions may be drawn on the comparative effectiveness of CIRT when compared to conventional photon therapy
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