The Emerging Role of Proton Therapy for Esophagus Cancer

Overview

Journal J Gastrointest Oncol

Date 2020 Mar 17

PMID 32175118

Citations 6

Authors

Krishan R Jethwa

Michael G Haddock

Erik J Tryggestad

Christopher L Hallemeier

Affiliations

Soon will be listed here.

Abstract

Chemoradiotherapy (CRT) plays an essential role in the treatment of esophageal cancer as either curative or neoadjuvant therapy. When delivered with conventional photon-based techniques, multiple adjacent organs at risk including the heart, lungs, kidneys, liver, stomach, and bowel, receive considerable radiation dose which may contribute to acute and late adverse events (AEs). Proton beam therapy (PBT) offers a reduction in radiation exposure to these organs and potentially an improvement in the therapeutic ratio. Herein we discuss the emerging role of PBT for esophageal cancer, including rationale, treatment planning, early dosimetric and clinical comparisons of PBT with photon-based techniques, ongoing prospective trials, and potential areas of opportunity for the incorporation of PBT with the goal of improving outcomes for patients with esophageal cancer.

Citing Articles

A Prospective Pilot Study of Pencil Beam Scanning Proton Radiation Therapy as a Component of Trimodality Therapy for Esophageal Cancer.

Hallemeier C, Merrell K, Neben-Wittich M, Jethwa K, Yoon H, Pitot H Adv Radiat Oncol. 2024; 9(8):101547.

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Proton Beam Therapy for Esophageal Cancer.

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Executive Summary of Clinical and Technical Guidelines for Esophageal Cancer Proton Beam Therapy From the Particle Therapy Co-Operative Group Thoracic and Gastrointestinal Subcommittees.

Chuong M, Hallemeier C, Li H, Zhu X, Zhang X, Tryggestad E Front Oncol. 2021; 11:748331.

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References

Fukada J, Shigematsu N, Takeuchi H, Ohashi T, Saikawa Y, Takaishi H . Symptomatic pericardial effusion after chemoradiation therapy in esophageal cancer patients. Int J Radiat Oncol Biol Phys. 2013; 87(3):487-93. DOI: 10.1016/j.ijrobp.2013.07.008. View

Chuong M, Hallemeier C, Jabbour S, Yu J, Badiyan S, Merrell K . Improving Outcomes for Esophageal Cancer using Proton Beam Therapy. Int J Radiat Oncol Biol Phys. 2016; 95(1):488-497. PMC: 10862360. DOI: 10.1016/j.ijrobp.2015.11.043. View

Yu J, Zhang X, Liao L, Li H, Zhu R, Park P . Motion-robust intensity-modulated proton therapy for distal esophageal cancer. Med Phys. 2016; 43(3):1111-8. DOI: 10.1118/1.4940789. View

Furukawa T, Inaniwa T, Sato S, Shirai T, Mori S, Takeshita E . Moving target irradiation with fast rescanning and gating in particle therapy. Med Phys. 2010; 37(9):4874-9. DOI: 10.1118/1.3481512. View

Sugahara S, Tokuuye K, Okumura T, Nakahara A, Saida Y, Kagei K . Clinical results of proton beam therapy for cancer of the esophagus. Int J Radiat Oncol Biol Phys. 2005; 61(1):76-84. DOI: 10.1016/j.ijrobp.2004.04.003. View

Mizumoto M, Sugahara S, Nakayama H, Hashii H, Nakahara A, Terashima H . Clinical results of proton-beam therapy for locoregionally advanced esophageal cancer. Strahlenther Onkol. 2010; 186(9):482-8. DOI: 10.1007/s00066-010-2079-4. View

Routman D, Garant A, Lester S, Day C, Harmsen W, Sanheuza C . A Comparison of Grade 4 Lymphopenia With Proton Versus Photon Radiation Therapy for Esophageal Cancer. Adv Radiat Oncol. 2019; 4(1):63-69. PMC: 6349594. DOI: 10.1016/j.adro.2018.09.004. View

Diehl A, Yarchoan M, Hopkins A, Jaffee E, Grossman S . Relationships between lymphocyte counts and treatment-related toxicities and clinical responses in patients with solid tumors treated with PD-1 checkpoint inhibitors. Oncotarget. 2018; 8(69):114268-114280. PMC: 5768402. DOI: 10.18632/oncotarget.23217. View

Liu C, Bhangoo R, Sio T, Yu N, Shan J, Chiang J . Dosimetric comparison of distal esophageal carcinoma plans for patients treated with small-spot intensity-modulated proton versus volumetric-modulated arc therapies. J Appl Clin Med Phys. 2019; 20(7):15-27. PMC: 6612702. DOI: 10.1002/acm2.12623. View

10.

Wei X, Liu H, Tucker S, Wang S, Mohan R, Cox J . Risk factors for pericardial effusion in inoperable esophageal cancer patients treated with definitive chemoradiation therapy. Int J Radiat Oncol Biol Phys. 2008; 70(3):707-14. DOI: 10.1016/j.ijrobp.2007.10.056. View

11.

Shiraishi Y, Xu C, Yang J, Komaki R, Lin S . Dosimetric comparison to the heart and cardiac substructure in a large cohort of esophageal cancer patients treated with proton beam therapy or Intensity-modulated radiation therapy. Radiother Oncol. 2017; 125(1):48-54. DOI: 10.1016/j.radonc.2017.07.034. View

12.

Herskovic A, Martz K, Al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V . Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992; 326(24):1593-8. DOI: 10.1056/NEJM199206113262403. View

13.

Lin S, Komaki R, Liao Z, Wei C, Myles B, Guo X . Proton beam therapy and concurrent chemotherapy for esophageal cancer. Int J Radiat Oncol Biol Phys. 2012; 83(3):e345-51. PMC: 3923631. DOI: 10.1016/j.ijrobp.2012.01.003. View

14.

Mori S, Wolfgang J, Lu H, Schneider R, Choi N, Chen G . Quantitative assessment of range fluctuations in charged particle lung irradiation. Int J Radiat Oncol Biol Phys. 2007; 70(1):253-61. DOI: 10.1016/j.ijrobp.2007.08.049. View

15.

Welsh J, Gomez D, Palmer M, Riley B, Mayankkumar A, Komaki R . Intensity-modulated proton therapy further reduces normal tissue exposure during definitive therapy for locally advanced distal esophageal tumors: a dosimetric study. Int J Radiat Oncol Biol Phys. 2011; 81(5):1336-42. PMC: 4086056. DOI: 10.1016/j.ijrobp.2010.07.2001. View

16.

Chandra A, Guerrero T, Liu H, Tucker S, Liao Z, Wang X . Feasibility of using intensity-modulated radiotherapy to improve lung sparing in treatment planning for distal esophageal cancer. Radiother Oncol. 2005; 77(3):247-53. DOI: 10.1016/j.radonc.2005.10.017. View

17.

Pan C, Kavanagh B, Dawson L, Li X, Das S, Miften M . Radiation-associated liver injury. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S94-100. PMC: 4388033. DOI: 10.1016/j.ijrobp.2009.06.092. View

18.

Abrams R, Winter K, Regine W, Safran H, Hoffman J, Lustig R . Failure to adhere to protocol specified radiation therapy guidelines was associated with decreased survival in RTOG 9704--a phase III trial of adjuvant chemotherapy and chemoradiotherapy for patients with resected adenocarcinoma of the pancreas. Int J Radiat Oncol Biol Phys. 2011; 82(2):809-16. PMC: 3133855. DOI: 10.1016/j.ijrobp.2010.11.039. View

19.

Zhang X, Zhao K, Guerrero T, McGuire S, Yaremko B, Komaki R . Four-dimensional computed tomography-based treatment planning for intensity-modulated radiation therapy and proton therapy for distal esophageal cancer. Int J Radiat Oncol Biol Phys. 2008; 72(1):278-87. PMC: 2610812. DOI: 10.1016/j.ijrobp.2008.05.014. View

20.

Mori S, Inaniwa T, Furukawa T, Takahashi W, Nakajima M, Shirai T . Amplitude-based gated phase-controlled rescanning in carbon-ion scanning beam treatment planning under irregular breathing conditions using lung and liver 4DCTs. J Radiat Res. 2014; 55(5):948-58. PMC: 4202290. DOI: 10.1093/jrr/rru032. View