Proton Beam Therapy for Esophageal Cancer.
Jea Giezl N SolidumRaniv D RojoJennifer Y WoEdward Christopher DeePublished in: Cancers (2022)
Early-stage esophageal cancer is often primarily managed surgically, with the addition of radiotherapy for locally advanced disease. However, current photon-based radiotherapy regimens and surgery results in a high incidence of treatment-related cardiac and pulmonary complications due to the involvement of proximal organs at risk. In addition, the anatomic location of the esophagus raises challenges for radiotherapy due to the anatomical changes associated with diaphragmatic motion, weight loss, tumor changes, and set-up variability. These challenges propelled the interest in proton beam therapy (PBT), which theoretically offers a reduction in the radiation exposure to healthy neighboring tissues with improvements in the therapeutic ratio. Several dosimetric studies support the potential advantages of PBT for esophageal cancer treatment however, translation of these results to improved clinical outcomes remains unclear with limited clinical data, especially in large populations. Studies on the effect on quality of life are likewise lacking. Here, we review the existing and emerging role of PBT for esophageal cancer, including treatment planning, early clinical comparisons of PBT with photon-based techniques, recently concluded and ongoing clinical trials, challenges and toxicities, effects on quality of life, and global inequities in the treatment of esophageal cancer.
Keyphrases
- early stage
- radiation therapy
- clinical trial
- radiation induced
- weight loss
- locally advanced
- minimally invasive
- risk factors
- gene expression
- stem cells
- sentinel lymph node
- randomized controlled trial
- left ventricular
- type diabetes
- pulmonary hypertension
- case control
- combination therapy
- living cells
- high resolution
- data analysis
- big data
- body mass index
- gastric bypass
- insulin resistance
- replacement therapy
- cell therapy
- phase ii
- mesenchymal stem cells
- study protocol
- human health
- single molecule
- weight gain