This latest review article examined the up-to-date clinical data of PBT for both early stage and locally advanced stage NSCLC. In particular, this review analyzed the reasons for the negative results of the only randomized phase II trial for a benefit of protons over photons in advanced NSCLC. This review points out that the greater experience in proton planning and delivery could lead to better outcomes, and such experience is a requisite to achieving desired results.

The overall lesson learned from utilizing the suboptimal design and execution of the phase II study will be hard-felt throughout the coming years. This only RCT result exacerbates the conundrum faced by those attempting to test proton therapy in NSCLC mainly due to insurance companies wanting data before they authorize a modality (protons). This review again stated that we must have more randomized results in order to understand whether proton therapy does provide a benefit in the advanced NSCLC setting. In addition, this review confirms that promises of protons in terms of reducing toxicity and suggests ways of advancing protons for NSCLC to the next level.