Proton beam therapy for non-small-cell lung cancer
BlueCross BlueShield Association
Record ID 32011000429
English
Authors' objectives:
This Assessment evaluates the health outcomes following PBT compared to SBRT for management of non-small-cell lung cancer.
The key question is how health outcomes (overall survival, disease-specific survival, local control, disease-free survival, and adverse events) with PBT compare with outcomes observed with SBRT.
This Assessment will specifically address the following 4 key questions:
1. In patients with stage I non-small-cell lung cancer who are not surgical candidates what are the comparative effects of PBT and SBRT for survival and tumor control outcomes?
2. In patients with more advanced non-small-cell lung cancer (stages II, III, or IV), or in patients with recurrent disease who are not surgical candidates, what are the comparative effects of PBT and SBRT for survival and tumor control outcomes?
3. In patients with stage I non-small-cell lung cancer who are not surgical candidates, what are the comparative effects of PBT and SBRT for adverse events?
4. In patients with more advanced non-small-cell lung cancer (stages II, III, or IV), or in patients with recurrent disease who are not surgical candidates, what are the comparative effects of PBT and SBRT for adverse events?
Ideally, in order to directly compare effectiveness of PBT with SBRT, randomized controlled studies comparing these modalities would be conducted with sufficient long-term follow-up to assess long-term survival and adverse event endpoints.
Authors' recommendations:
Overall, evidence is insufficient to permit conclusions about the results of PBT for any stage of non-small-cell lung cancer. All PBT studies are case series; there are no studies directly comparing PBT and SBRT. Among study quality concerns, no study mentioned using an independent assessor of patient reported adverse events, adverse events were generally poorly reported, and details were lacking on several aspects of PBT treatment regimens. The PBT studies had similar patient ages, but there was great variability in percent within stage Ia, sex ratio, and percent medically inoperable. There is a high degree of treatment heterogeneity among the PBT studies, particularly with respect to planning volume, total dose, number of fractions, and number of beams. Survival results are highly variable. It is unclear if the heterogeneity of results can be explained by differences in patient and treatment characteristics. Indirect comparisons between PBT and SBRT, comparing separate sets of single-arm studies on PBT and SBRT, may be distorted by confounding. In the absence of randomized, controlled trials, the comparative effectiveness of PBT and SBRT is uncertain.
Details
Project Status:
Completed
Year Published:
2010
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
United States
MeSH Terms
- Lung Neoplasms
- Protons
- Radiotherapy
Contact
Organisation Name:
BlueCross BlueShield Association
Contact Address:
BlueCross BlueShield Association, Technology Evaluation Center, 225 North Michigan Ave, Chicago, Illinois, USA. Tel: 888 832 4321
Contact Name:
tec@bcbsa.com
Contact Email:
tec@bcbsa.com
Copyright:
BlueCross BlueShield Association (BCBS)