Proton therapy for small cell lung cancer

Abstract

The prognosis of limited-stage small cell lung cancer (LS-SCLC) continues to improve and is now roughly comparable to that of locally advanced non-small cell lung cancer (NSCLC). This shift, taken together with the decreased toxicities of modern radiotherapy (RT) for LS-SCLC compared with those reported in historical trials, necessitates further evaluation of whether proton beam therapy (PBT) could further reduce both acute and late toxicities for patients receiving concurrent chemoradiotherapy for LS-SCLC. These notions are discussed theoretically, with an emphasis on cardiac events. This is followed by a review of the published evidence to date demonstrating improved dosimetry with PBT over intensity-modulated RT and encouraging safety and efficacy profiles seen in early clinical reports. In addition to covering technical aspects of PBT for LS-SCLC such as intensity-modulated PBT, image-guidance for PBT, and adaptive planning, this review also discusses the need for increased data on intensity-modulated PBT for LS-SCLC, economic and quality of life analyses for future PBT SCLC studies, careful categorization of cardiac events in these patients, and the role for immunotherapy combined with photon- or proton-based RT for LS-SCLC.

Treatments for combined small cell lung cancer patients

“…Surgical treatment has been proved to be beneficial not (8). We observed the similar results in IA-IB CSCLC patients as previous studies, which indicated the importance of surgical treatment in early stage of CSCLC.…”

“…Moon and his colleagues used the same database to study early stage of SCLC from 1988 to 2014. They reported the CSCLC cases accounted for 6.4% of SCLC in their cohort (8). However, the proportion of CSCLC was just 2.1% in our cohort.…”

“…The previous studies indicated that CSCLC accounted for 5-14% of SCLC (4)(5)(6)(7)(8). The actual incidence may be higher than the previous report because most of CSCLC cases were diagnosed from surgical specimens.…”

“…Yang et al reported that pT1-2N0M0 SCLC patients could be beneficial from adjuvant chemotherapy with/without cranial irradiation (14). Moon and his colleagues reported that surgery with chemoradiation provided better cancer-specific survival (CSS) in T1-2N0-1M0 SCLC while CSCLC patients might benefit from multimodality (8). The optimal treatments for CSCLC in each stage are not fully verified.…”

miR-216a-5p inhibits malignant progression in small cell lung cancer: involvement of the Bcl-2 family proteins

“… 1 SCLC tumors generally become chemoresistant after effective chemotherapy treatments, and most patients die from a recurrence of cancer or from serious complications. 2 Hence, it is important to explore the molecular mechanisms underlying SCLC progression. microR-NAs (miRNAs), a type of small noncoding RNA with a length of 19–25 nucleotides, can inhibit the expression of their target genes by binding to their 3′-UTR, resulting in mRNA degradation or posttranslational repression.…”