Can proton beam therapy be clinically relevant for the management of lung cancer?

Lung cancer is the leading cause of cancer death in the USA and worldwide. Radiation has played a significant role in the treatment of all types and stages of lung cancer. Despite improvement in lung cancer treatment over the past few decades, the mortality and treatment morbidities for lung cancer patients remain high. Lung cancer treatment often requires multi-modality approaches. Radiation therapy (RT) for lung cancer is challenging due to pre-existing morbidity, poor lung tolerance and its location near by critical organs (heart, esophagus, spinal cord). Conventional RT with photon has improved, but has reached a plateau. Particle beam therapy is promising due to the ability to spare normal surrounding tissues from unnecessary collateral radiation. Particle beam therapy has been used in the past decade in USA and Japan with encouraging results. This article will review the basic physics and radiobiology of particle beam therapy and their role in the management of early stage, locally advanced, and recurrent lung cancer.