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Review
. 2020 Feb;11(1):144-156.
doi: 10.21037/jgo.2019.11.04.

The emerging role of proton therapy for esophagus cancer

Krishan R Jethwa  1 , Michael G Haddock  2 , Erik J Tryggestad  2 , Christopher L Hallemeier  2
Affiliations
Review

The emerging role of proton therapy for esophagus cancer

Krishan R Jethwa et al. J Gastrointest Oncol. 2020 Feb.

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.

Keywords: Esophagus cancer; chemoradiation; proton therapy.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Pencil beam scanning proton therapy (PBS-PBT, A,B,C) and intensity modulated photon radiotherapy (IMRT, D,E,F) plans for a patient with clinical T2N1M0 adenocarcinoma of the distal esophagus treated with neoadjuvant chemoradiotherapy. The prescribed dose is 50 Gy to the high-risk clinical target volume (gross tumor volume + 1 cm) and 45 Gy to the low-risk clinical target volume (elective gastroesophageal mucosa and regional lymph nodes), delivered in 25 fractions. Note similar distribution of the high-dose volume (50–45 Gy, red and orange), but substantial reduction in the moderate-low dose (30–5 Gy, green and blue) with PBS-PBT vs. IMRT. Notably, there is significant reduction in dose to the heart and lungs with PBS-PBT vs. IMRT.
Figure 2
Figure 2
Dose-volume histogram for the patient shown in Figure 1 with adenocarcinoma of the distal esophagus, planned with pencil beam scanning proton therapy (PBS-PBT, squares) and intensity modulated photon radiotherapy (IMRT, triangles). Coverage of the 50 Gy (magenta) and 45 Gy (cyan) clinical target volumes is equivalent with PBT-PBT and IMRT. The PBS-PBT plan has a significantly lower mean heart (red, 6.7 vs. 16 Gy) and lung (green, 2.0 vs. 9.4 Gy) dose compared to IMRT.
See this image and copyright information in PMC

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