Feasibility of dose escalation for NSCLC using IMPT

Activity: Talk and presentationAcademic presentationAcademic


Poster presentation of the following scientific abstract:

Feasibility of dose escalation for non-small-cell lung cancer using proton therapy

With current chemoradiotherapy, local control for non-small-cell lung cancer is between 60 and 85%. Dose escalation to improve locoregional control has been attempted previously, but resulted in improved mortality. Radiotherapy in these earlier trials involved IMRT and 3D-CRT. Mortality was associated with heart dose and esophageal toxicity. We hypothesized that dose escalation may be feasible without a significant increase in dose to heart and esophagus by using proton therapy. The aim of this planning study was to test this hypothesis by making dose escalation proton therapy plans.

Proton therapy treatment plans were created prescribing 73 Gy to the IGTVp ≥1 cm outside the PRV of the mediastinal envelope, and 64 Gy to the GTV inside the PRV of the envelope. The maximum V70Gy of the mediastinal envelope was 2cm^3 in the voxelwise maximum robust evaluation. Organ at risk doses in the nominal plans were compared to the 60 Gy clinical proton therapy plans.

In the first three treatment plans made so far, dose escalation was feasibly with doses to lung outside GTV, heart and esophagus similar to the 60 Gy plans. More plans will be added and evaluated in the coming months.

Dose escalation to the IGTVp in non-small-cell lung cancer without compromising dose to heart and esophagus is feasible when using proton therapy, especially for patients with an IGTVp lying mostly outside the mediastinal envelope. The clinical translation of these findings requires a subsequent randomized controlled trial.
Event titlePTCOG 2022
Event typeConference
LocationMiami, United StatesShow on map
Degree of RecognitionInternational


  • Radiotherapy
  • Non-small cell lung cancer
  • Dose escalation
  • Treatment Planning
  • Organ at risk