A Cancer Treatment Supported by Research
Numerous clinical research studies have demonstrated that when compared to traditional photon radiation, proton therapy provides excellent tumor control and typically results in fewer short- and long-term side effects and toxicities. Many of these studies have been led by New York Proton Center physicians.
Proton Therapy Research Studies
These are some of the research studies demonstrating proton therapy’s ability to reduce short- and long-term side effects and toxicities across numerous tumor types.
Brain Tumors
Brown PD, Chung C, Liu DD, et al. A prospective phase II randomized trial of proton radiotherapy vs intensity-modulated radiotherapy for patients with newly diagnosed glioblastoma. Neuro Oncol. 2021;23(8):1337-1347. doi:10.1093/neuonc/noab040
Summary: Findings from this clinical trial noted no difference in time to cognitive failure among patients with brain tumors. However, it found that the patients who received proton therapy reported reduced toxicity and fatigue.
Breast Cancer
Mutter RW, Choi JI, Jimenez RB, et al. Proton Therapy for Breast Cancer: A Consensus Statement From the Particle Therapy Cooperative Group Breast Cancer Subcommittee. Int J Radiat Oncol Biol Phys. 2021;111(2):337-359. doi:10.1016/j.ijrobp.2021.05.110
Summary: This evidence-based review from the breast subcommittee of the Particle Therapy Cooperative Group (PTCOG) summarizes the potential applications, published clinical data, optimal techniques, and ongoing research initiatives of proton therapy in the management of breast cancer.
Choi JI, Khan AJ, Powell SN, McCormick B, Lozano AJ, Del Rosario G, Mamary J, Liu H, Fox P, Gillespie E, Braunstein LZ, Mah D, Cahlon O. Proton reirradiation for recurrent or new primary breast cancer in the setting of prior breast irradiation. Radiother Oncol. 2021 Dec;165:142-151.
Summary: This study is the largest to date of proton therapy reirradiation for breast cancer recurrence or new primary cancer after prior definitive breast or chest wall radiotherapy. The study authors found excellent locoregional control and few high-grade toxicities with proton therapy.
Esophageal Cancer
Lin SH, Hobbs BP, Verma V, et al. Randomized Phase IIB Trial of Proton Beam Therapy Versus Intensity-Modulated Radiation Therapy for Locally Advanced Esophageal Cancer. J Clin Oncol. 2020;38(14):1569-1579. doi:10.1200/JCO.19.02503
Summary: This study compared total toxicity burden and progression-free survival, finding that patients treated with proton therapy had reduced risk of adverse events related to treatment.
Xi M, Xu C, Liao Z, et al. Comparative Outcomes After Definitive Chemoradiotherapy Using Proton Beam Therapy Versus Intensity Modulated Radiation Therapy for Esophageal Cancer: A Retrospective, Single-Institutional Analysis. Int J Radiat Oncol Biol Phys. 2017;99(3):667-676. doi:10.1016/j.ijrobp.2017.06.2450
Summary: Results of this study indicate that proton therapy may be associated with improved overall survival and progression-free survival, especially in patients with locally advanced disease who received chemoradiation.
Lin SH, Merrell KW, Shen J, et al. Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer. Radiother Oncol. 2017;123(3):376-381. doi:10.1016/j.radonc.2017.04.013
Summary: In patients who required surgery as part of their esophageal cancer treatment, proton therapy displayed the greatest benefits and reduced post-operative complications and hospital length of stay.
Head and Neck Cancers
Patel SH, Wang Z, Wong WW, et al. Charged particle therapy versus photon therapy for paranasal sinus and nasal cavity malignant diseases: a systematic review and meta-analysis. Lancet Oncol. 2014;15(9):1027-1038. doi:10.1016/S1470-2045(14)70268-2
Summary: This results of this case review suggest that proton therapy may result in better outcomes for patients treated for sinus and nasal cavity tumors.
Li X, Kitpanit S, Lee A, et al. Toxicity Profiles and Survival Outcomes Among Patients With Nonmetastatic Nasopharyngeal Carcinoma Treated With Intensity-Modulated Proton Therapy vs Intensity-Modulated Radiation Therapy. JAMA Netw Open. 2021;4(6):e2113205.
Summary: This study of patients newly diagnosed with nonmetastatic nasopharyngeal carcinoma found that intensity modulated proton therapy (IMPT) treatment was associated with significantly fewer acute adverse events compared with standard-of-care IMRT, with rare late complications.
Hepatocellular (Liver) Cancers
Sanford NN, Pursley J, Noe B, et al. Protons versus Photons for Unresectable Hepatocellular Carcinoma: Liver Decompensation and Overall Survival. Int J Radiat Oncol Biol Phys. 2019;105(1):64-72. doi:10.1016/j.ijrobp.2019.01.076
Summary: This study found that proton therapy offered improved survival that may be associated with decreased incidence of post-treatment liver decompensation.
Hasan S, Abel S, Verma V, et al. Proton beam therapy versus stereotactic body radiotherapy for hepatocellular carcinoma: practice patterns, outcomes, and the effect of biologically effective dose escalation. J Gastrointest Oncol. 2019;10(5):999-1009. doi:10.21037/jgo.2019.08.03
Summary: This study found that proton therapy may allow for safer escalation of radiation dose and may contribute to improved overall survival.
Lower Gastrointestinal Cancers
Choi JI, Wojcieszynski A, Amos R, Giap H, Apisarnthanarax S, Ashman JB, Anand A, Perles L, Williamson T, Ramkumar S, Molitoris J, Simone CB 2nd, Chuong MD. PTCOG Gastrointestinal Subcommittee Lower Gastrointestinal Tract Malignancies Consensus Statement: Proton Therapy Indications, Treatment Delivery and Case Discussion. Int J Part Ther. 2023; in press.
Summary: Eleven recommendations on clinical indications for which PBT should be considered are presented with supporting literature. The authors found that proton therapy may be of significant value in select patients with lower gastrointestinal malignancies.
Lung Cancer
Boyce-Fappiano D, Nguyen QN, Chapman BV, et al. Single Institution Experience of Proton and Photon-based Postoperative Radiation Therapy for Non-small-cell Lung Cancer. Clin Lung Cancer. 2021;22(5):e745-e755.
Summary: This retrospective review of patients treated with radiation therapy following surgery for non-small cell lung cancer found proton therapy offered improved cardiac and lung sparing, and reduced toxicity compared with IMRT.
Higgins KA, O’Connell K, Liu Y, et al. National Cancer Database Analysis of Proton Versus Photon Radiation Therapy in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys. 2017;97(1):128-137. doi:10.1016/j.ijrobp.2016.10.001
Summary: This retrospective study of patients with stages I-IV non-small cell lung cancer suggests that proton therapy is associated with improved survival.
Chi A, Chen H, Wen S, Yan H, Liao Z. Comparison of particle beam therapy and stereotactic body radiotherapy for early stage non-small cell lung cancer: A systematic review and hypothesis-generating meta-analysis. Radiother Oncol. 2017;123(3):346-354. doi:10.1016/j.radonc.2017.05.007
Summary: This retrospective review found that proton therapy was associated with improved overall survival and progression-free survival. It also noted a higher incidence of severe toxicity among the patients who received stereotactic body radiotherapy (SBRT).
Pediatric Cancers
Kahalley LS, Peterson R, Ris MD, et al. Superior Intellectual Outcomes After Proton Radiotherapy Compared With Photon Radiotherapy for Pediatric Medulloblastoma. J Clin Oncol. 2020;38(5):454-461. doi:10.1200/JCO.19.01706
Summary: This trial of medulloblastoma patients evaluated change in intellectual scores over time. It found that due to proton therapy’s tissue-sparing qualities, children who treated with protons had more favorable intellectual outcomes.
Prostate Cancer
Cancer o Hoppe BS, Michalski JM, Mendenhall NP, et al. Comparative effectiveness study of patient-reported outcomes after proton therapy or intensity-modulated radiotherapy for prostate cancer.
Summary: This study of men who received intensity modulated radiation therapy (IMRT) or intensity modulated proton therapy (IMPT) for prostate cancer found a lower incidence of gastrointestinal side effects among the men who received IMPT.
Sosa AJ, Thames HD, Sanders JW, et al. Proton therapy for the management of localized prostate cancer: Long-term clinical outcomes at a comprehensive cancer center. Radiother Oncol. 2023;188:109854.
Summary: In this study, proton therapy demonstrated excellent clinical outcomes, even among higher-risk groups.
Recurrent Cancers
Verma V, Rwigema JM, Malyapa RS, Regine WF, Simone CB 2nd. Systematic assessment of clinical outcomes and toxicities of proton radiotherapy for reirradiation. Radiother Oncol. 2017;125(1):21-30. doi:10.1016/j.radonc.2017.08.005
Summary: This assessment demonstrated the safety of proton therapy in treating several types of recurrent cancer including central nervous system, head and neck, lung, and gastrointestinal cancers.
Proton Reirradiation: Expert Recommendations for Reducing Toxicities and Offering New Chances of Cure in Patients With Challenging Recurrence Malignancies
Charles B. Simone, II, John P. Plastaras, Salma K. Jabbour, Anna Lee, Nancy Y. Lee, J. Isabelle Choi, Steven J. Frank, Joe Y. Chang, Jeffrey Bradley
Summary: This study provides data supporting the increasing role of proton therapy, including pencil beam scanning, in reirradiation of thoracic, head and neck, and pelvic malignancies.
Skull Base Cancers and Chordomas
Zhou J, Yang B, Wang X, Jing Z. Comparison of the Effectiveness of Radiotherapy with Photons and Particles for Chordoma After Surgery: A Meta-Analysis. World Neurosurg. 2018;117:46-53. doi:10.1016/j.wneu.2018.05.209
Summary: Results of this study indicated that proton therapy was more effective than stereotactic body radiation therapy (SBRT) with photons
Chhabra AM, Rice SR, Holtzman A, Choi JI, Hasan S, Press RH, Chang J, Halasz L, Tsai HK, Wang CJ, Kabolizadeh P, Gondi V, Hartsell WF, Vora SA, Vargas CE, Simone CB 2nd. Clinical outcomes and toxicities of 100 patients treated with proton therapy for chordoma on the proton collaborative group prospective registry. Radiother Oncol. 2023 Jun;183:109551. doi: 10.1016/j.radonc.2023.109551. Epub 2023 Feb 20. PMID: 36813169.
Summary: This prospective Proton Collaborative Group study found excellent safety and efficacy outcomes among patients treated with proton therapy, and a low rate of treatment failure.
