Proton Beam Therapy and Concurrent Chemotherapy for Esophageal Cancer

Komaki, Ritsuko; Zhongxing, Liao; Wei, Caimiao; Myles, Bevan; Xiaomao, Guo; Palmer, Matthew; Mohan, Radhe; Swisher, Stephen G; Hofstetter, Wayne L; Ajani, Jaffer A; Cox, James D

doi:10.1016/J.IJROBP.2012.01.003

Title: Proton Beam Therapy and Concurrent Chemotherapy for Esophageal Cancer

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Abstract

Purpose: Proton beam therapy (PBT) is a promising modality for the management of thoracic malignancies. We report our preliminary experience of treating esophageal cancer patients with concurrent chemotherapy (CChT) and PBT (CChT/PBT) at MD Anderson Cancer Center. Methods and Materials: This is an analysis of 62 esophageal cancer patients enrolled on a prospective study evaluating normal tissue toxicity from CChT/PBT from 2006 to 2010. Patients were treated with passive scattering PBT with two- or three-field beam arrangement using 180 to 250 MV protons. We used the Kaplan-Meier method to assess time-to-event outcomes and compared the distributions between groups using the log-rank test. Results: The median follow-up time was 20.1 months for survivors. The median age was 68 years (range, 38-86). Most patients were males (82%) who had adenocarcinomas (76%) and Stage II-III disease (84%). The median radiation dose was 50.4 Gy (RBE [relative biologic equivalence]) (range, 36-57.6). The most common grade 2 to 3 acute toxicities from CChT/PBT were esophagitis (46.8%), fatigue (43.6%), nausea (33.9%), anorexia (30.1%), and radiation dermatitis (16.1%). There were two cases of grade 2 and 3 radiation pneumonitis and two cases of grade 5 toxicities. A total of 29 patients (46.8%) received preoperative CChT/PBT, with onemore »« less

Authors:

Komaki, Ritsuko; Zhongxing, Liao ^[1]; Wei, Caimiao ^[2]; Myles, Bevan ^[1]; Xiaomao, Guo ^[3]; Palmer, Matthew ^[1]; Mohan, Radhe ^[4]; Swisher, Stephen G; Hofstetter, Wayne L ^[5]; Ajani, Jaffer A ^[6]; Cox, James D ^[1]

Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China)
Department of Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

Publication Date:: Sun Jul 01 00:00:00 EDT 2012

OSTI Identifier:: 22058901

Resource Type:: Journal Article

Journal Name:: International Journal of Radiation Oncology, Biology and Physics

Additional Journal Information:: Journal Volume: 83; Journal Issue: 3; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016

Country of Publication:: United States

Language:: English

Subject:: 62 RADIOLOGY AND NUCLEAR MEDICINE; ANOREXIA; CARCINOMAS; CHEMOTHERAPY; DEATH; DERMATITIS; ESOPHAGUS; FATIGUE; MALES; METASTASES; NAUSEA; PATIENTS; PNEUMONITIS; POLYMERASE CHAIN REACTION; PROTON BEAMS; PROTONS; RADIATION DOSES; RADIOTHERAPY; RBE; SURGERY; TOXICITY

Citation Formats


                    Lin, Steven H., E-mail: shlin@mdanderson.org, Komaki, Ritsuko, Zhongxing, Liao, Wei, Caimiao, Myles, Bevan, Xiaomao, Guo, Palmer, Matthew, Mohan, Radhe, Swisher, Stephen G, Hofstetter, Wayne L, Ajani, Jaffer A, and Cox, James D. Proton Beam Therapy and Concurrent Chemotherapy for Esophageal Cancer.  United States: N. p., 2012. 
        Web.  doi:10.1016/J.IJROBP.2012.01.003.

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                    Lin, Steven H., E-mail: shlin@mdanderson.org, Komaki, Ritsuko, Zhongxing, Liao, Wei, Caimiao, Myles, Bevan, Xiaomao, Guo, Palmer, Matthew, Mohan, Radhe, Swisher, Stephen G, Hofstetter, Wayne L, Ajani, Jaffer A, & Cox, James D. Proton Beam Therapy and Concurrent Chemotherapy for Esophageal Cancer.  United States.  https://doi.org/10.1016/J.IJROBP.2012.01.003

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                    Lin, Steven H., E-mail: shlin@mdanderson.org, Komaki, Ritsuko, Zhongxing, Liao, Wei, Caimiao, Myles, Bevan, Xiaomao, Guo, Palmer, Matthew, Mohan, Radhe, Swisher, Stephen G, Hofstetter, Wayne L, Ajani, Jaffer A, and Cox, James D. 2012.  
        "Proton Beam Therapy and Concurrent Chemotherapy for Esophageal Cancer".  United States.  https://doi.org/10.1016/J.IJROBP.2012.01.003.

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@article{osti_22058901,

  title        = {Proton Beam Therapy and Concurrent Chemotherapy for Esophageal Cancer},

  author       = {Lin, Steven H., E-mail: shlin@mdanderson.org and Komaki, Ritsuko and Zhongxing, Liao and Wei, Caimiao and Myles, Bevan and Xiaomao, Guo and Palmer, Matthew and Mohan, Radhe and Swisher, Stephen G and Hofstetter, Wayne L and Ajani, Jaffer A and Cox, James D},

  abstractNote = {Purpose: Proton beam therapy (PBT) is a promising modality for the management of thoracic malignancies. We report our preliminary experience of treating esophageal cancer patients with concurrent chemotherapy (CChT) and PBT (CChT/PBT) at MD Anderson Cancer Center. Methods and Materials: This is an analysis of 62 esophageal cancer patients enrolled on a prospective study evaluating normal tissue toxicity from CChT/PBT from 2006 to 2010. Patients were treated with passive scattering PBT with two- or three-field beam arrangement using 180 to 250 MV protons. We used the Kaplan-Meier method to assess time-to-event outcomes and compared the distributions between groups using the log-rank test. Results: The median follow-up time was 20.1 months for survivors. The median age was 68 years (range, 38-86). Most patients were males (82%) who had adenocarcinomas (76%) and Stage II-III disease (84%). The median radiation dose was 50.4 Gy (RBE [relative biologic equivalence]) (range, 36-57.6). The most common grade 2 to 3 acute toxicities from CChT/PBT were esophagitis (46.8%), fatigue (43.6%), nausea (33.9%), anorexia (30.1%), and radiation dermatitis (16.1%). There were two cases of grade 2 and 3 radiation pneumonitis and two cases of grade 5 toxicities. A total of 29 patients (46.8%) received preoperative CChT/PBT, with one postoperative death. The pathologic complete response (pCR) rate for the surgical cohort was 28%, and the pCR and near CR rates (0%-1% residual cells) were 50%. While there were significantly fewer local-regional recurrences in the preoperative group (3/29) than in the definitive CChT/PBT group (16/33) (log-rank test, p = 0.005), there were no differences in distant metastatic (DM)-free interval or overall survival (OS) between the two groups. Conclusions: This is the first report of patients treated with PBT/CChT for esophageal cancer. Our data suggest that this modality is associated with a few severe toxicities, but the pathologic response and clinical outcomes are encouraging. Prospective comparison with more traditional approach is warranted.},

  doi          = {10.1016/J.IJROBP.2012.01.003},

  url          = {https://www.osti.gov/biblio/22058901},
  journal      = {International Journal of Radiation Oncology, Biology and Physics},

  issn         = {0360-3016},

  number       = 3,

  volume       = 83,

  place        = {United States},

  year         = {Sun Jul 01 00:00:00 EDT 2012},

  month        = {Sun Jul 01 00:00:00 EDT 2012}

}

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