Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes
Purpose: When treating esophageal cancer with radiation therapy, it is critical to limit the dose to surrounding structures, such as the lung and/or heart, as much as possible. Proton radiation therapy allows a reduced radiation dose to both the heart and lungs, potentially reducing the risk of card...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Particle Therapy Co-operative Group
2022-12-01
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| Series: | International Journal of Particle Therapy |
| Subjects: | |
| Online Access: | https://theijpt.org/doi/pdf/10.14338/IJPT-22-00021.1 |
| _version_ | 1797204393627484160 |
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| author | Michael S. Rutenberg, MD, PhD Bradford S. Hoppe, MD, MPH Jason S. Starr, DO Ziad Awad, MD Mathew Thomas, MBBS, MD Christopher G. Morris, MS Perry Johnson, PhD Randal H. Henderson, MD, MBA Jeremy C. Jones, MD Bharatsinh Gharia, MBBS, MD Steven Bowers, MD Herbert C. Wolfsen, MD Sunil Krishnan, MBBS, MD Stephen J. Ko, MD Hani M. Babiker, MD Romaine C. Nichols, Jr, MD |
| author_facet | Michael S. Rutenberg, MD, PhD Bradford S. Hoppe, MD, MPH Jason S. Starr, DO Ziad Awad, MD Mathew Thomas, MBBS, MD Christopher G. Morris, MS Perry Johnson, PhD Randal H. Henderson, MD, MBA Jeremy C. Jones, MD Bharatsinh Gharia, MBBS, MD Steven Bowers, MD Herbert C. Wolfsen, MD Sunil Krishnan, MBBS, MD Stephen J. Ko, MD Hani M. Babiker, MD Romaine C. Nichols, Jr, MD |
| author_sort | Michael S. Rutenberg, MD, PhD |
| collection | DOAJ |
| description | Purpose: When treating esophageal cancer with radiation therapy, it is critical to limit the dose to surrounding structures, such as the lung and/or heart, as much as possible. Proton radiation therapy allows a reduced radiation dose to both the heart and lungs, potentially reducing the risk of cardiopulmonary toxicity. Here, we report disease control, survival, and toxicity outcomes among patients with esophageal cancer treated with proton radiation therapy and concurrent chemotherapy (chemoradiation therapy; CRT) with or without surgery.
Materials and Methods: We enrolled 17 patients with thoracic esophageal carcinoma on a prospective registry between 2010 and 2021. Patients received proton therapy to a median dose of 50.4-GyRBE (range, 50.4–64.8) in 1.8-Gy fractions.Acute and late toxicities were graded per the Common Terminology Criteria for Adverse Events, version 4.0 (US National Cancer Institute, Bethesda, Maryland). In addition, disease control, patterns of failure, and survival outcomes were collected.
Results: Nine patients received preoperative CRT, and 8 received definitive CRT. Overall, 88% of patients had adenocarcinoma, and 12% had squamous cell carcinoma. With a median follow-up of 2.1 years (range, 0.5–9.4), the 3-year local progression-free, disease-free, and overall survival rates were 85%, 66%, and 55%, respectively. Two patients (1 with adenocarcinoma and 1 with squamous cell carcinoma) recurred at the primary site after refusing surgery after a complete clinical response to CRT. The most common acute nonhematologic and hematologic toxicities, respectively, were grades 1 to 3 esophagitis and grades 1 to 4 leukopenia, both affecting 82% of patients. No acute cardiopulmonary toxicities were observed in the absence of surgical resection. Reagarding surgical complications, 3 postoperative cardiopulmonary complications occurred as follows: 1 grade 1 pleural effusion, 1 grade 3 pleural effusion, and 1 grade 2 anastomotic leak. Two severe late CRT toxicities occurred: 1 grade 5 tracheoesophageal fistula and 1 grade 3 esophageal stenosis requiring a feeding tube.
Conclusion: Proton radiation therapy is a safe, effective treatment for esophageal cancer with increasing evidence supporting its role in reducing cardiopulmonary toxicity. |
| first_indexed | 2024-04-10T19:12:11Z |
| format | Article |
| id | doaj.art-6e0ce34c85cc410c8a3e146ab69d68ad |
| institution | Directory Open Access Journal |
| issn | 2331-5180 |
| language | English |
| last_indexed | 2024-04-24T08:34:31Z |
| publishDate | 2022-12-01 |
| publisher | Particle Therapy Co-operative Group |
| record_format | Article |
| series | International Journal of Particle Therapy |
| spelling | doaj.art-6e0ce34c85cc410c8a3e146ab69d68ad2024-04-16T17:39:45ZengParticle Therapy Co-operative GroupInternational Journal of Particle Therapy2331-51802022-12-01182910.14338/IJPT-22-00021.1i2331-5180-9-3-18Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival OutcomesMichael S. Rutenberg, MD, PhD0Bradford S. Hoppe, MD, MPH1Jason S. Starr, DO2Ziad Awad, MD3Mathew Thomas, MBBS, MD4Christopher G. Morris, MS5Perry Johnson, PhD6Randal H. Henderson, MD, MBA7Jeremy C. Jones, MD8Bharatsinh Gharia, MBBS, MD9Steven Bowers, MD10Herbert C. Wolfsen, MD11Sunil Krishnan, MBBS, MD12Stephen J. Ko, MD13Hani M. Babiker, MD14Romaine C. Nichols, Jr, MD151 Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA1 Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA2 Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA3 Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, USA4 Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA5 Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA5 Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA5 Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA2 Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA6 Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA4 Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA7 Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL, USA1 Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA1 Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA2 Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA5 Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USAPurpose: When treating esophageal cancer with radiation therapy, it is critical to limit the dose to surrounding structures, such as the lung and/or heart, as much as possible. Proton radiation therapy allows a reduced radiation dose to both the heart and lungs, potentially reducing the risk of cardiopulmonary toxicity. Here, we report disease control, survival, and toxicity outcomes among patients with esophageal cancer treated with proton radiation therapy and concurrent chemotherapy (chemoradiation therapy; CRT) with or without surgery. Materials and Methods: We enrolled 17 patients with thoracic esophageal carcinoma on a prospective registry between 2010 and 2021. Patients received proton therapy to a median dose of 50.4-GyRBE (range, 50.4–64.8) in 1.8-Gy fractions.Acute and late toxicities were graded per the Common Terminology Criteria for Adverse Events, version 4.0 (US National Cancer Institute, Bethesda, Maryland). In addition, disease control, patterns of failure, and survival outcomes were collected. Results: Nine patients received preoperative CRT, and 8 received definitive CRT. Overall, 88% of patients had adenocarcinoma, and 12% had squamous cell carcinoma. With a median follow-up of 2.1 years (range, 0.5–9.4), the 3-year local progression-free, disease-free, and overall survival rates were 85%, 66%, and 55%, respectively. Two patients (1 with adenocarcinoma and 1 with squamous cell carcinoma) recurred at the primary site after refusing surgery after a complete clinical response to CRT. The most common acute nonhematologic and hematologic toxicities, respectively, were grades 1 to 3 esophagitis and grades 1 to 4 leukopenia, both affecting 82% of patients. No acute cardiopulmonary toxicities were observed in the absence of surgical resection. Reagarding surgical complications, 3 postoperative cardiopulmonary complications occurred as follows: 1 grade 1 pleural effusion, 1 grade 3 pleural effusion, and 1 grade 2 anastomotic leak. Two severe late CRT toxicities occurred: 1 grade 5 tracheoesophageal fistula and 1 grade 3 esophageal stenosis requiring a feeding tube. Conclusion: Proton radiation therapy is a safe, effective treatment for esophageal cancer with increasing evidence supporting its role in reducing cardiopulmonary toxicity.https://theijpt.org/doi/pdf/10.14338/IJPT-22-00021.1radiation therapyparticle therapycancer outcomescancer side effects |
| spellingShingle | Michael S. Rutenberg, MD, PhD Bradford S. Hoppe, MD, MPH Jason S. Starr, DO Ziad Awad, MD Mathew Thomas, MBBS, MD Christopher G. Morris, MS Perry Johnson, PhD Randal H. Henderson, MD, MBA Jeremy C. Jones, MD Bharatsinh Gharia, MBBS, MD Steven Bowers, MD Herbert C. Wolfsen, MD Sunil Krishnan, MBBS, MD Stephen J. Ko, MD Hani M. Babiker, MD Romaine C. Nichols, Jr, MD Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes International Journal of Particle Therapy radiation therapy particle therapy cancer outcomes cancer side effects |
| title | Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes |
| title_full | Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes |
| title_fullStr | Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes |
| title_full_unstemmed | Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes |
| title_short | Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes |
| title_sort | proton therapy with concurrent chemotherapy for thoracic esophageal cancer toxicity disease control and survival outcomes |
| topic | radiation therapy particle therapy cancer outcomes cancer side effects |
| url | https://theijpt.org/doi/pdf/10.14338/IJPT-22-00021.1 |
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