Hypofractionated and stereotactic body proton radiotherapy for a high-risk lung cancer cohort: A multi-institutional experience from the proton collaborative group prospective registry
In brief
Proton therapy controlled 83% of high-risk lung tumors at one year
In a prospective registry of 104 patients with 110 lung tumors, proton radiation achieved local control in 83% of tumors at one year and 77% at two years. No severe treatment-related toxicities were reported, and control was similar in larger, ultracentral and previously irradiated tumors; limited follow-up leaves long-term results uncertain.
- Journal
- Clinical and translational radiation oncology (Q1)
- Published
- 15 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Alexander J Allen, Charles B Simone, Kai Sun, David F Alicia, Ajay Banskota, Gopal K Bajaj, et al.
- PMID
- 42787797
- DOI
- 10.1016/j.ctro.2026.101291
Why clinicians should know about it
- Picked for Medical Physics (top studies of the week, 27 September 2026): Proton SBRT/HFRT shows safety in high‑risk lung cohort
Abstract
INTRODUCTION: Lung cancer is commonly treated with stereotactic body radiotherapy (SBRT) and hypofractionated RT (HFRT). Delivering these ablative regimens with proton beam therapy (PBT) may yield dosimetric and clinical advantages, particularly for high-risk cases. We evaluated safety and efficacy of SBRT/HFRT PBT for lung tumors, including unfavorable subgroups. METHODS: Adults with lung tumors treated with PBT ≤15 fractions were identified from a prospective, multi-institutional registry. Eligible regimens included 4-5 fractions at ≥10Gy/fraction (≥48Gy total) or 8-15 fractions at ≥3.5Gy/fraction (≥52.5Gy total). Local control (LC) was estimated using cumulative incidence with death as a competing risk, and Fine-Gray models were used for subgroup comparisons. RESULTS: 104 patients with 110 tumors (83.6% non-small cell lung cancer) were included: 32.7% ≥4 cm, 41.8% ultracentral, and 30% re-irradiated. Most common regimens were 60Gy/15 fractions (40%) and 50Gy/5 fractions (17.2%); 71.8% received intensity-modulated PBT. 1-and 2-year LC rates were 83.1% and 77.4%, with no difference by tumor size, ultracentral location, or re-irradiation. Internal gross tumor volume receiving 95% of dose was associated with improved LC (p = 0.007). Most common toxicities were cough (40%) and dyspnea (34.5%), with no Grade ≥ 3 events. CONCLUSIONS: In the largest prospectively enrolled report of SBRT/HFRT via intensity-modulated PBT for a high-risk lung tumor cohort, 1- and 2-year LC rates were 83.1% and 77.4%, with no grade ≥ 3 toxicities. LC was similar among high-risk subgroups. However, short survival and follow-up durations limited assessment of the findings. Despite the prospective registry, reliable long-term follow-up data remained limited for many patients, somewhat restricting result interpretation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.