Concurrent chemoradiotherapy (CCRT) is a standard treatment approach for many patients with early stage, non-metastatic cancers. While this approach is highly effective in reducing tumor size and can be curative in some patients, it is often associated with severe side effects that can impact patient quality-of-life. Proton beam radiotherapy (PBRT) is an alternative to traditional radiotherapy (RT) that is generally thought to be safer. In a retrospective study published recently in JAMA Oncology, investigators compared the safety and efficacy of PBRT to RT in 1483 adults with nonmetastatic, locally advanced cancer receiving concurrent chemotherapy with curative intent.
Ninety days post-treatment, patients receiving PBRT had significantly lower rates of adverse events (AEs) of grade 3 or higher (11.5% vs 27.6%; HR 0.31, P = .002) compared to patients receiving traditional RT. There were also reduced rates of lower grade toxicities in patients receiving PBRT (74.2% vs 84.8%; HR 0.78, P = .006). Furthermore, significantly fewer patients treated with PBRT experienced a decline in performance status during treatment compared to patients treated with traditional RT (HR 0.51, P<.001). There were no differences in disease-free survival (DFS; HR 0.84, P = .55) or overall survival (OS; HR 0.73, P = .34) between the two treatment groups.
The authors concluded that PBRT given concurrently with chemotherapy is associated with significantly reduced rates of acute AEs compared to traditional CCRT, with no difference in performance outcomes including survival. While these results require verification in a prospective randomized trial, the authors suggest that PBRT may be a preferred treatment approach for patients with locally advanced, non-metastatic cancer.
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JAMA Oncol. 2019 Dec 26. [Epub ahead of print.]