Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes.

Autor:	Rutenberg MS; Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA., Hoppe BS; Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA., Starr JS; Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA., Awad Z; Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, USA., Thomas M; Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA., Morris CG; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA., Johnson P; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA., Henderson RH; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA., Jones JC; Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA., Gharia B; Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA., Bowers S; Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA., Wolfsen HC; Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL, USA., Krishnan S; Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA., Ko SJ; Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA., Babiker HM; Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA., Nichols RC Jr; Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA.
Jazyk:	angličtina
Zdroj:	International journal of particle therapy [Int J Part Ther] 2022 Dec 19; Vol. 9 (3), pp. 18-29. Date of Electronic Publication: 2022 Dec 19 (Print Publication: 2023).
DOI:	10.14338/IJPT-22-00021.1
Abstrakt:	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. Competing Interests: Conflicts of Interest: Bradford Hoppe, MD, MPH, and Perry Johnson, PhD, are Associate Editors of the International Journal of Particle Therapy. All other authors have no relevant conflicts of interest to disclose. (©Copyright 2022 The Author(s).)
Databáze:	MEDLINE
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