Concurrent Chemotherapy and Proton Beam Therapy for Esophageal Cancer

Abstract

Purpose/Objective(s)Concurrent chemoradiation with or without surgery is the treatment of choice for patients with esophageal cancer. Proton beam therapy has been used as a single modality for inoperable patients. However, there has no experience in using proton concurrently with chemotherapy for esophageal cancer. The purpose of the study is to report the preliminary results of concurrent chemotherapy and proton beam therapy compared with intensity modulated radiation for locally advanced esophageal cancer.Materials/MethodsWe treated 53 and 18 esophageal cancer patients with either intensity modulated radiation (IMRT) or proton beam therapy (PBT) between 2004 and 2008. Patient-, disease, treatment parameters, and toxicity were compared between the two groups. Kaplan-Meier Survival estimates on overall survival (OS) and disease specific survival (DSS) was calculated from the end day of radiotherapy. The differences between the groups were tested using Log-rank analysis.ResultsThere was no difference in sex, gender, histology, stage, smoking status between the groups. The patients in PCT group were older (p = 0.0084), all consumed alcohol (p = 0.002), had better performance status (0.005), and more N1 disease (p = 0.044). Median IMRT dose was 50.4 Gy (range, 45-66Gy), and median PCT dose was 50.4 (range 36-54) Cobalt Gray Equivalent (CGE). All patients had concurrent chemotherapy. Treatment related esophagitis, pneumonitis, and dermatitis were low in either group. No statistically significant differences exist in treatment related esophagitis, pneumonitis, dermatitis, or the rates of OS and DSS between the two groups.ConclusionsOur preliminary results show that PCT treatment with concurrent chemotherapy for esophageal cancer is feasible. Additional analyses on metabolic and pathological response in patients treated in the 2 groups are ongoing. Purpose/Objective(s)Concurrent chemoradiation with or without surgery is the treatment of choice for patients with esophageal cancer. Proton beam therapy has been used as a single modality for inoperable patients. However, there has no experience in using proton concurrently with chemotherapy for esophageal cancer. The purpose of the study is to report the preliminary results of concurrent chemotherapy and proton beam therapy compared with intensity modulated radiation for locally advanced esophageal cancer. Concurrent chemoradiation with or without surgery is the treatment of choice for patients with esophageal cancer. Proton beam therapy has been used as a single modality for inoperable patients. However, there has no experience in using proton concurrently with chemotherapy for esophageal cancer. The purpose of the study is to report the preliminary results of concurrent chemotherapy and proton beam therapy compared with intensity modulated radiation for locally advanced esophageal cancer. Materials/MethodsWe treated 53 and 18 esophageal cancer patients with either intensity modulated radiation (IMRT) or proton beam therapy (PBT) between 2004 and 2008. Patient-, disease, treatment parameters, and toxicity were compared between the two groups. Kaplan-Meier Survival estimates on overall survival (OS) and disease specific survival (DSS) was calculated from the end day of radiotherapy. The differences between the groups were tested using Log-rank analysis. We treated 53 and 18 esophageal cancer patients with either intensity modulated radiation (IMRT) or proton beam therapy (PBT) between 2004 and 2008. Patient-, disease, treatment parameters, and toxicity were compared between the two groups. Kaplan-Meier Survival estimates on overall survival (OS) and disease specific survival (DSS) was calculated from the end day of radiotherapy. The differences between the groups were tested using Log-rank analysis. ResultsThere was no difference in sex, gender, histology, stage, smoking status between the groups. The patients in PCT group were older (p = 0.0084), all consumed alcohol (p = 0.002), had better performance status (0.005), and more N1 disease (p = 0.044). Median IMRT dose was 50.4 Gy (range, 45-66Gy), and median PCT dose was 50.4 (range 36-54) Cobalt Gray Equivalent (CGE). All patients had concurrent chemotherapy. Treatment related esophagitis, pneumonitis, and dermatitis were low in either group. No statistically significant differences exist in treatment related esophagitis, pneumonitis, dermatitis, or the rates of OS and DSS between the two groups. There was no difference in sex, gender, histology, stage, smoking status between the groups. The patients in PCT group were older (p = 0.0084), all consumed alcohol (p = 0.002), had better performance status (0.005), and more N1 disease (p = 0.044). Median IMRT dose was 50.4 Gy (range, 45-66Gy), and median PCT dose was 50.4 (range 36-54) Cobalt Gray Equivalent (CGE). All patients had concurrent chemotherapy. Treatment related esophagitis, pneumonitis, and dermatitis were low in either group. No statistically significant differences exist in treatment related esophagitis, pneumonitis, dermatitis, or the rates of OS and DSS between the two groups. ConclusionsOur preliminary results show that PCT treatment with concurrent chemotherapy for esophageal cancer is feasible. Additional analyses on metabolic and pathological response in patients treated in the 2 groups are ongoing. Our preliminary results show that PCT treatment with concurrent chemotherapy for esophageal cancer is feasible. Additional analyses on metabolic and pathological response in patients treated in the 2 groups are ongoing.