# Bayesian adaptive randomization trial of passive scattering proton therapy and intensity-modulated photon radiotherapy for locally advanced non-small-cell lung cancer

Source: https://onco.cc/key-papers/paper-liao-proton-vs-imrt-nsclc-jco-2018/  
OnCo record `paper-liao-proton-vs-imrt-nsclc-jco-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The first randomised comparison of protons with modern photon radiotherapy for lung cancer. Protons spared the heart but not the lung overall, and neither severe lung inflammation nor local failure was reduced: 10.5 per cent against 6.5 per cent for lung inflammation, 10.5 against 10.9 per cent for local failure.

## Summary

Liao and colleagues randomised patients with stage IIB to IIIB non-small-cell lung cancer having chemoradiotherapy to passive scattering proton therapy or intensity-modulated photon radiotherapy. Each patient had both plans made, and was eligible for randomisation only if both met the same organ dose constraints at the same tumour dose. Compared with photons (92 patients), protons (57) exposed less lung to 5 to 10 Gy(RBE), more lung to 20 Gy(RBE) or more, and less heart at all dose levels. Grade 3 or worse radiation pneumonitis occurred in 6.5 per cent with photons and 10.5 per cent with protons; local failure in 10.9 and 10.5 per cent. The posterior probability of photons being better was 0.54. Both endpoints improved over the course of the trial in both arms.

## Fields

- Kind: Key paper
- Last checked: 2026-10-20
- Tags: precision; radiation
- Journal: Journal of Clinical Oncology
- Year: 2018
- DOI: 10.1200/JCO.2017.74.0720
- Authors: Liao Z, Lee JJ, Komaki R, et al.
- Findings: Grade 3 or worse radiation pneumonitis: 6.5 per cent with photons, 10.5 per cent with protons.; Local failure: 10.9 per cent with photons, 10.5 per cent with protons.; Protons exposed less heart at all dose levels from 5 to 80 Gy(RBE) and more lung to 20 Gy(RBE) or more.
- What it means: The physical advantage of protons did not, in this trial, translate into less lung damage or better control. It used an older proton technique without pencil-beam scanning, so it does not settle the question for current proton treatment.
- Caveats: Passive scattering protons, since largely replaced by pencil-beam scanning.; Bayesian adaptive design with unequal arms (57 and 92); not powered as a conventional superiority trial.; Outcomes improved in both arms over time, suggesting a learning curve.

## Sources

- Journal of Clinical Oncology 2018: https://doi.org/10.1200/JCO.2017.74.0720
- PubMed 29293386: https://pubmed.ncbi.nlm.nih.gov/29293386/

## Connected records

- pairings: [Caution: proton therapy vs IMRT](https://onco.cc/pairings/proton-vs-imrt/)
- cancers: [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Pencil-beam scanning and intensity-modulated proton therapy](https://onco.cc/technologies/intensity-modulated-proton-therapy/), [Proton therapy](https://onco.cc/technologies/proton-therapy/)
- terms: [Proton range uncertainty and the range margin](https://onco.cc/terms/proton-range-uncertainty/), [Radiation pneumonitis and lung fibrosis](https://onco.cc/terms/radiation-pneumonitis/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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