Puneeth Iyengar, MD, PhD, Talks Pros and Cons of Proton Therapy for Stage III NSCLC

Dr Iyengar, University of Texas Southwestern Medical Center, Dallas, discusses the pros and cons of using proton therapy in the management of patients with stage III NSCLC.

Transcript:

Dr. Puneeth Iyengar:  My name is Puneeth Iyengar, and I'm an Assistant Professor of Radiation Oncology at UT Southwestern Medical Center in Dallas. My focus is on treating lung cancer patients with radiation, and combining it with systemic therapies and surgery as necessary.

Our session here at the conference was to basically discuss the roles of different treatments for stage III non-small cell lung cancer.

There's been certainly an evolution in the treatment of these patients, but I approached it from a radiation perspective. Specifically, I wanted to talk about the pros and cons of using proton therapy in the management of stage III non-small cell lung cancer patients.

There's lot of controversy...I wouldn't say controversy, but there's a lot of debate as to whether protons would be efficacious in the management of these patients. A lot of investigators and scientists would argue that photons or just standard radiation therapy approaches would be just fine.

What I wanted to do in our talk today was provide a perspective to suggest that in radiation oncology, we have a number of different tools. These are, for instance, SBRT or stereotactic body radiation therapy as a tool, the use of photons as a tool, the use of protons as a tool.

Within the context of IMRT and the use of protons and photons, we use IMRT or intensity-modulated radiation therapy. That allows us to shape the radiation around the tumor and avoid normal tissue toxicity, but we can apply that technique with photons or even protons.

My argument was that we have a number of different tools in radiation oncology, and really need to match the tool with the appropriate patient selection criteria.

What mean by that is, there are some patients with lung cancer, whose disease is well away from critical structures. Maybe proton therapy would not be an ideal treatment for those patients, but there are patients whose disease is right up against the esophagus, right up against the heart.

In those scenarios, the use of protons may actually be beneficial to basically treat the disease as effectively as possible while blocking the effects on the normal tissues.

What we've learned over the course of time is that, with increasing use of immunotherapy such that patients are living longer, there's more chances that we see toxicity in further follow-up with these lung cancer patient populations.

Secondly, what we've noticed is that because these patients are living longer, it gives their cancers chances to come back, and more often than not, the cancers come back in the chest.

For a variety of reasons, we think protons would be beneficial from a toxicity perspective as well as for controlling the disease, because we could go to a higher potential dose while still avoiding those normal tissue toxicities.

That's the presentation that I've provided today, and provided some case perspective on that.