Proton-Based Chemoradiotherapy—What Level of Evidence Is Necessary to Justify Its Widespread Use?
Menée à partir de données portant sur 1 483 patients adultes atteints d'un cancer de stade localement avancé, cette étude évalue, du point de vue de la réduction du risque d'événements indésirables nécessitant une hospitalisation non programmée, l'intérêt d'une protonthérapie par rapport à une radiothérapie photonique, dans le cadre d'une chimioradiothérapie concomitante
In this issue of JAMA Oncology, Baumann et al present a large single-institution retrospective analysis of proton- vs photon-based radiotherapy specifically for patients receiving concurrent chemotherapy for 11 types of locally advanced cancers. Patients undergoing proton therapy overall had significantly fewer grade 3 toxic effects requiring hospitalization at 90 days, as well as fewer grade 2 toxic effects at 90 days and a smaller decline in performance status during treatment.The authors should be commended for assembling a large cohort of patients who may have the most to gain from proton therapy given their combined risk of recurrence and treatment complications. Although much effort has surrounded the study of proton therapy in localized prostate and breast cancer, which are among the most prevalent cancers in the United States, it is not clear that proton therapy would provide a substantial benefit for patients who already tend to have excellent cure rates and relatively few high-grade adverse effects. On the other hand, patients with locally advanced disease often choose to accept highly toxic doses of chemotherapy and radiotherapy to maximize their probability of long-term disease control.
JAMA Oncology , commentaire, 2018