"For patients with advanced inoperable stage  lung cancer concurrent chemotherapy and the specialized radiation treatment proton therapy offers improved survival compared to historical data for standard of care according to a new study from The University of Texas MD Anderson Cancer Center.    The research published in JAMA Oncology reported an overall survival OS of . months. In contrast the historical OS rate with standard of care concurrent chemotherapy and traditional radiation was  months at the time when the study was designed.    The findings are the final results of the single institution Phase II study and represent the longest followup to date of stage  lung cancer patients who have received proton therapy said Joe Y. Chang M.D. professor Radiation Oncology and the studys corresponding author.    Lung cancer is the leading cause of cancer death in both men and women in the U.S. According to the American Cancer Society more than  people will be diagnosed and  will die from the disease in  with the majority of patients still being diagnosed when the disease is in an advanced stage.    Advanced lung cancer patients with inoperable disease traditionally have been treated with concurrent chemotherapy and conventional photon radiation therapy. However the therapy can be very difficult for patients due to associated toxicities and because many patients are also dealing with comorbidities explained Chang.    Proton therapy is an advanced type of radiation treatment that uses a beam of protons to deliver radiation directly to the tumor destroying cancer cells while sparing healthy tissues. Protons enter the body with a low radiation dose and stop at the tumor matching its shape and volume or depth. They deposit the bulk of their cancerfighting energy right at the tumor thereby reducing the dose to cardiopulmonary structures which impacts the toxicity functional status quality of life and even survival for patients explained Chang.    With our study we hypothesized that proton therapy would offer a survival benefit to patients and reduce treatmentassociated toxicities which can be very serious he said.    The study opened at MD Anderson in  in this research Chang and his colleague report on the studys fiveyear results.    For the prospective Phase II trial  patients with inoperable Stage III nonsmallcell lung cancer were enrolled. The studys primary endpoint was OS. The researchers hypothesized that the median OS would increase from historical data of  months on standard therapy to  months. Secondary endpoints included distant metastasis and local and regional recurrence rates. Toxic effects of treatment in both the acute and late settings also were analyzed.    Median follow up was . months for all patients and . months for alive patients. At five years the median OS was . months and the corresponding fiveyear OS was  percent. Median progressionfree survival was . months with a fiveyear progressionfree survival of  percent.    In sum  patients experienced a relapse with distant sites representing  percent of all recurrences. Local and regional recurrence rates were low  percent and  percent respectively.    Among the acute and late toxic effects diagnosed in patients were esophagitis pneumonitis and cardiac arrhythmia. Of note said Chang no patients developed the most severe or grade five toxicities as seen in patients who receive standard of care.    Chang noted his study is not without limitations. Of greatest significance the study was designed more than a decade ago. While the studys survival recurrence rates and toxic effects are still favorable when compared to rates associated with the most advanced traditional photon radiation therapy intensity modulated radiation therapy IMRT technology to diagnose and stage the disease as well all treatment modalities have significantly improved.    When the study opened PET imaging had just been approved for lung cancer staging. The image quality was poor and didnt include a CT component in most facilities across the country said Chang. Obviously the technology has improved dramatically over the last decade and has made a significant impact on diagnosis and staging. Also delivery of both the conventional intensitymodulated radiation therapy IMRT and proton therapy IMPT have improved thereby reducing side effects for both treatment modalities.    For example MD Anderson proton therapy patients with advanced lung cancer now can receive IMPT. The technique uses an intricate network of magnets to aim a narrow proton beam at a tumor and paint the radiation dose onto it layer by layer. Healthy tissue surrounding the tumor is spared and side effects are even more reduced than earlier proton delivery said Chang.    A Phase II trial studying IMPT and concurrent chemotherapy is underway.    Chang also noted the advancements in cancer biology and immunotherapy and that both are important areas of research focus in combination with proton therapy.       In addition to Chang other authors on the allMD Anderson study include Stephen Hahn M.D. Ritsuko Komaki M.D. Pamela K. Allen Ph.D. Zhongxing Liao M.D. Steven H. Lin M.D. Ph.D. Daniel Gomez M.D. James Welsh M.D. Melenda Jeter M.D. James Cox M.D. Michael OReilly M.D. Ming Li M.D. and Wencheng Zhang M.D. all of Radiation Oncology John V. Heymach M.D. Ph.D. and Charles Lu M.D. both of ThoracicHead and Neck Medical Oncology Ronald X. Zhu Ph.D. Xiaodong Zhang Ph.D. Heng Li Ph.D. Radhe Mohan Ph.D. all of Radiation Physics and Ara A. Vaporciyan M.D. Thoracic and Cardiovascular Surgery. Vivek Verma M.D. now at the University of Nebraska Medical Center also contributed to the study."