Pathologic complete response (pCR) rates and outcomes after neoadjuvant chemoradiotherapy with proton or photon radiation for adenocarcinomas of the esophagus and gastroesophageal junction.

Autor:	DeCesaris CM; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA., Berger M; University of Maryland School of Medicine, Baltimore, MD, USA., Choi JI; New York Proton Center, New York, NY, USA., Carr SR; Department of Thoracic Surgery, University of Maryland Medical Center, Baltimore, MD, USA., Burrows WM; Department of Thoracic Surgery, University of Maryland Medical Center, Baltimore, MD, USA., Regine WF; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA., Simone CB 2nd; New York Proton Center, New York, NY, USA., Molitoris JK; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal oncology [J Gastrointest Oncol] 2020 Aug; Vol. 11 (4), pp. 663-673.
DOI:	10.21037/jgo-20-205
Abstrakt:	Background: Pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) is associated with improved survival in patients treated for esophageal cancer. While proton beam therapy (PBT) has been demonstrated to reduce toxicities with nCRT, no data comparing pCR rates between modalities exist to date. We investigated pCR rates in patients with distal esophageal/GEJ adenocarcinomas undergoing trimodality therapy with nCRT-PBT or photon-based nCRT with the hypothesis that pathologic responses with PBT would be at least as high as with photon therapy. Methods: A single-institutional review of patients with distal esophageal adenocarcinoma treated with trimodality therapy from 2015-2018 using PBT was completed. PBT patients were matched 1:2 to patients treated with photons. Chi square and two-sample t -tests were utilized to compare characteristics, and the Kaplan Meier method was used to estimate oncologic endpoints. Results: Eighteen consecutive PBT patients were identified and compared to 36 photon patients. All patients received concurrent chemotherapy; 98% with carboplatin/paclitaxel. Most patients were male (91%) and White (89%); median age was 62 years (range, 31-76 years). Median radiation dose in both cohorts was 50.4 Gy (range, 41.4-50.4 Gy); all courses were delivered in 1.8Gy fractions. Age, gender and race were well balanced. Patients treated with PBT had a significantly higher pre-treatment nodal stage (N) and AJCC 7 th edition stage grouping (P=0.02, P=0.03). Despite this, tumoral and nodal clearance and pCR rates were equivalent between cohorts (P=0.66, P=0.11, P=0.63, respectively). Overall pCR and individual primary and nodal clearance rates, overall survival (OS), locoregional control (LRC), and distant metastatic control did not significantly differ between modalities (all P>0.05). Major perioperative events were balanced; however, there were 5 (14%) perioperative deaths in the photon cohort compared to 0 (0%) in the proton cohort (P=0.06). Conclusions: The use of PBT in trimodality therapy for distal esophageal adenocarcinoma yields pCR rates comparable to photon radiation and historical controls. Pathologic responses and oncologic outcomes in this study did not differ significantly between modalities despite PBT patients having higher AJCC stages and nodal disease burdens. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at: http://dx.doi.org/10.21037/jgo-20-205). The authors have no conflicts of interest to declare. (2020 Journal of Gastrointestinal Oncology. All rights reserved.)
Databáze:	MEDLINE
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