Comparative Outcomes After Definitive Chemoradiotherapy Using Proton Beam Therapy Versus Intensity Modulated Radiation Therapy for Esophageal Cancer: A Retrospective, Single-Institutional Analysis

2017 ◽  
Vol 99 (3) ◽  
pp. 667-676 ◽  
Author(s):  
Mian Xi ◽  
Cai Xu ◽  
Zhongxing Liao ◽  
Joe Y. Chang ◽  
Daniel R. Gomez ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Proton Beam ◽  
Institutional Analysis ◽  
Intensity Modulated Radiation Therapy ◽  
Proton Beam Therapy ◽  
Definitive Chemoradiotherapy ◽  
Intensity Modulated

scholarly journals Dosimetric advantages of proton beam therapy compared to intensity-modulated radiation therapy for retroperitoneal chordoma

Rare Tumors ◽  
2019 ◽  
Vol 11 ◽  
pp. 203636131987851 ◽  
Author(s):  
Nathan Y Yu ◽  
Sujay A Vora
Keyword(s):  
Radiation Therapy ◽  
Proton Beam ◽  
Intensity Modulated Radiation Therapy ◽  
Proton Beam Therapy ◽  
Intensity Modulated ◽  
Spot Scanning ◽  
Prescription Dose ◽  
Biological Effectiveness ◽  
Primary Bone ◽  
Rare Diagnosis

Retroperitoneal chordomas are exceedingly rare and account for less than 5% of all primary bone malignancies. Their etiology remains unknown. We report a rare case of an extravertebral chordoma of the retroperitoneum in a 71-year-old man treated with surgical resection and post-operative spot-scanning proton beam therapy. We describe how to safely treat a retroperitoneal target to a prescription dose over 70 Gy (relative biological effectiveness) with spot-scanning proton beam therapy and also report a dosimetric comparison of spot-scanning proton beam therapy versus intensity-modulated radiation therapy. This case not only highlights a rare diagnosis of an extravertebral retroperitoneal chordoma but it also draws attention to the dosimetric advantages of proton beam therapy and illustrates a promising radiotherapeutic option for retroperitoneal targets.

scholarly journals Comparing Proton Beam to Intensity Modulated Radiation Therapy Planning in Esophageal Cancer

2015 ◽  
Vol 1 (4) ◽  
pp. 866-877 ◽  
Author(s):  
Jingya Wang ◽  
Matthew Palmer ◽  
Stephen D. Bilton ◽  
Khoi N. Vu ◽  
Shari Greer ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Proton Beam ◽  
Intensity Modulated Radiation Therapy ◽  
Therapy Planning ◽  
Intensity Modulated ◽  
Radiation Therapy Planning

scholarly journals Randomized Phase IIB Trial of Proton Beam Therapy Versus Intensity-Modulated Radiation Therapy for Locally Advanced Esophageal Cancer

2020 ◽  
Vol 38 (14) ◽  
pp. 1569-1579 ◽  
Author(s):  
Steven H. Lin ◽  
Brian P. Hobbs ◽  
Vivek Verma ◽  
Rebecca S. Tidwell ◽  
Grace L. Smith ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Interim Analysis ◽  
Locally Advanced ◽  
Intensity Modulated Radiation Therapy ◽  
Proton Beam Therapy ◽  
Advanced Esophageal Cancer ◽  
Intensity Modulated ◽  
Locally Advanced Esophageal Cancer

PURPOSE Whether dosimetric advantages of proton beam therapy (PBT) translate to improved clinical outcomes compared with intensity-modulated radiation therapy (IMRT) remains unclear. This randomized trial compared total toxicity burden (TTB) and progression-free survival (PFS) between these modalities for esophageal cancer. METHODS This phase IIB trial randomly assigned patients to PBT or IMRT (50.4 Gy), stratified for histology, resectability, induction chemotherapy, and stage. The prespecified coprimary end points were TTB and PFS. TTB, a composite score of 11 distinct adverse events (AEs), including common toxicities as well as postoperative complications (POCs) in operated patients, quantified the extent of AE severity experienced over the duration of 1 year following treatment. The trial was conducted using Bayesian group sequential design with three planned interim analyses at 33%, 50%, and 67% of expected accrual (adjusted for follow-up). RESULTS This trial (commenced April 2012) was approved for closure and analysis upon activation of NRG-GI006 in March 2019, which occurred immediately prior to the planned 67% interim analysis. Altogether, 145 patients were randomly assigned (72 IMRT, 73 PBT), and 107 patients (61 IMRT, 46 PBT) were evaluable. Median follow-up was 44.1 months. Fifty-one patients (30 IMRT, 21 PBT) underwent esophagectomy; 80% of PBT was passive scattering. The posterior mean TTB was 2.3 times higher for IMRT (39.9; 95% highest posterior density interval, 26.2-54.9) than PBT (17.4; 10.5-25.0). The mean POC score was 7.6 times higher for IMRT (19.1; 7.3-32.3) versus PBT (2.5; 0.3-5.2). The posterior probability that mean TTB was lower for PBT compared with IMRT was 0.9989, which exceeded the trial’s stopping boundary of 0.9942 at the 67% interim analysis. The 3-year PFS rate (50.8% v 51.2%) and 3-year overall survival rates (44.5% v 44.5%) were similar. CONCLUSION For locally advanced esophageal cancer, PBT reduced the risk and severity of AEs compared with IMRT while maintaining similar PFS.

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