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The emerging role of proton therapy for esophagus cancer.

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.

SUBMITTER: Jethwa KR

PROVIDER: S-EPMC7052753 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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The emerging role of proton therapy for esophagus cancer.

Jethwa Krishan R KR Haddock Michael G MG Tryggestad Erik J EJ Hallemeier Christopher L CL

Journal of gastrointestinal oncology 20200201 1

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 th ...[more]

PMID: 32175118

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Project description:Simple Summary Hypofractionation is a radiation oncology concept in which larger doses per fraction are administered and therefore less fractions are prescribed in a given treatment course. This concept has been increasingly utilized in recent years in external beam radiotherapy (EBRT). Hypofractionation has the potential benefits of reducing the length of treatment and also treatment costs. In the case of proton beam therapy (PBT), which is a limited resource with only 99 facilities currently in operation worldwide in 2021, hypofractionation also has the benefit of potentially increasing the number of patients able to access PBT. This review article will discuss the reported clinical data and radiobiology of hypofractionated PBT. The aim is to report on the current knowledge of hypofractionation in PBT and the issues which still require investigation. Over 50 published manuscripts reporting clinical results involving hypofractionation and PBT were included in this review, where the most common treatment regions were prostate, lung and liver. Future clinical trials are still needed to determine the optimal fractionation regime. Abstract Hypofractionated radiotherapy is an attractive approach for minimizing patient burden and treatment cost. Technological advancements in external beam radiotherapy (EBRT) delivery and image guidance have resulted in improved targeting and conformality of the absorbed dose to the disease and a reduction in dose to healthy tissue. These advances in EBRT have led to an increasing adoption and interest in hypofractionation. Furthermore, for many treatment sites, proton beam therapy (PBT) provides an improved absorbed dose distribution compared to X-ray (photon) EBRT. In the past 10 years there has been a notable increase in reported clinical data involving hypofractionation with PBT, reflecting the interest in this treatment approach. This review will discuss the reported clinical data and radiobiology of hypofractionated PBT. Over 50 published manuscripts reporting clinical results involving hypofractionation and PBT were included in this review, ~90% of which were published since 2010. The most common treatment regions reported were prostate, lung and liver, making over 70% of the reported results. Many of the reported clinical data indicate that hypofractionated PBT can be well tolerated, however future clinical trials are still needed to determine the optimal fractionation regime.

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The emerging role of proton therapy for esophagus cancer.

Publications

The emerging role of proton therapy for esophagus cancer.

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