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

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 card...

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Autores principales: Rutenberg, Michael S., Hoppe, Bradford S., Starr, Jason S., Awad, Ziad, Thomas, Mathew, Morris, Christopher G., Johnson, Perry, Henderson, Randal H., Jones, Jeremy C., Gharia, Bharatsinh, Bowers, Steven, Wolfsen, Herbert C., Krishnan, Sunil, Ko, Stephen J., Babiker, Hani M., Nichols, Romaine C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Particle Therapy Co-operative Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9875824/
https://www.ncbi.nlm.nih.gov/pubmed/36721483
http://dx.doi.org/10.14338/IJPT-22-00021.1
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author Rutenberg, Michael S.
Hoppe, Bradford S.
Starr, Jason S.
Awad, Ziad
Thomas, Mathew
Morris, Christopher G.
Johnson, Perry
Henderson, Randal H.
Jones, Jeremy C.
Gharia, Bharatsinh
Bowers, Steven
Wolfsen, Herbert C.
Krishnan, Sunil
Ko, Stephen J.
Babiker, Hani M.
Nichols, Romaine C.
author_facet Rutenberg, Michael S.
Hoppe, Bradford S.
Starr, Jason S.
Awad, Ziad
Thomas, Mathew
Morris, Christopher G.
Johnson, Perry
Henderson, Randal H.
Jones, Jeremy C.
Gharia, Bharatsinh
Bowers, Steven
Wolfsen, Herbert C.
Krishnan, Sunil
Ko, Stephen J.
Babiker, Hani M.
Nichols, Romaine C.
author_sort Rutenberg, Michael S.
collection PubMed
description 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.
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spelling pubmed-98758242023-01-30 Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes Rutenberg, Michael S. Hoppe, Bradford S. Starr, Jason S. Awad, Ziad Thomas, Mathew Morris, Christopher G. Johnson, Perry Henderson, Randal H. Jones, Jeremy C. Gharia, Bharatsinh Bowers, Steven Wolfsen, Herbert C. Krishnan, Sunil Ko, Stephen J. Babiker, Hani M. Nichols, Romaine C. Int J Part Ther Original Articles 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. The Particle Therapy Co-operative Group 2022-12-19 /pmc/articles/PMC9875824/ /pubmed/36721483 http://dx.doi.org/10.14338/IJPT-22-00021.1 Text en ©Copyright 2022 The Author(s) https://creativecommons.org/licenses/by/3.0/Distributed under Creative Commons CC-BY. Open Access (http://creativecommons.org/licenses/by/3.0/ (https://creativecommons.org/licenses/by/3.0/) ).
spellingShingle Original Articles
Rutenberg, Michael S.
Hoppe, Bradford S.
Starr, Jason S.
Awad, Ziad
Thomas, Mathew
Morris, Christopher G.
Johnson, Perry
Henderson, Randal H.
Jones, Jeremy C.
Gharia, Bharatsinh
Bowers, Steven
Wolfsen, Herbert C.
Krishnan, Sunil
Ko, Stephen J.
Babiker, Hani M.
Nichols, Romaine C.
Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes
title Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes
title_full Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes
title_fullStr Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes
title_full_unstemmed Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes
title_short Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes
title_sort proton therapy with concurrent chemotherapy for thoracic esophageal cancer: toxicity, disease control, and survival outcomes
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9875824/
https://www.ncbi.nlm.nih.gov/pubmed/36721483
http://dx.doi.org/10.14338/IJPT-22-00021.1
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