Parzen Jacob S, Chuong Michael D, Chang John, Rosen Lane, Urbanic James, Hartsell William, Tsai Henry, Sinesi Christopher, Zeng Jing, Mishra Mark, Vargas Carlos, Stevens Craig, Kabolizadeh Peyman
Beaumont Proton Therapy Center, Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
Miami Cancer Institute, Department of Radiation Oncology, Miami, Florida.
Adv Radiat Oncol. 2021 Jul 15;6(5):100751. doi: 10.1016/j.adro.2021.100751. eCollection 2021 Sep-Oct.
Concurrent chemoradiation plays an integral role in the treatment of esophageal cancer. Proton beam radiation therapy has the potential to spare adjacent critical organs, improving toxicity profiles and potentially improving clinical outcomes.
We evaluated the REG001-09 registry for patients undergoing proton radiation therapy for esophageal cancer. Demographic, clinicopathologic, toxicity, and dosimetry information were compiled.
We identified 155 patients treated at 10 institutions between 2010 and 2019. One hundred twenty (77%) had adenocarcinoma and 34 (22%) had squamous cell carcinoma. One hundred thirty-seven (88%) received concurrent chemotherapy. The median delivered dose was 50.51 Gy-equivalent (GyE; range, 41.4-70.1). Grade ≥3 toxicities occurred in 22 (14%) of patients and were most commonly dysphagia (6%), esophagitis (4%), anorexia (4%), and nausea (2%). There were no episodes of grade ≥4 lymphopenia and no grade 5 toxicities. The average mean heart, lung, and liver doses and average maximum spinal cord dose were 10.0 GyE, 4.8 GyE, 3.8 GyE, and 34.2 GyE, respectively. For gastroesophageal junction tumors, 8% of patients developed acute grade ≥3 toxicity and the mean heart, liver, right kidney, and left kidney doses were 10.5 GyE, 3.9 GyE, 0.4 GyE, and 4.9 GyE, respectively. Gastroesophageal junction location was protective against development of grade ≥3 toxicity on univariate ( = .0009) and multivariate ( = .004) analysis.
Proton beam radiation therapy affords excellent dosimetric parameters and low toxicity in patients with esophageal cancer treated with curative intent. Prospective trials are underway investigating the comparative benefit of proton-based therapy.
同步放化疗在食管癌治疗中起着不可或缺的作用。质子束放射治疗有可能使相邻关键器官免受辐射，改善毒性特征并有可能改善临床结局。
我们评估了REG001 - 09登记处中接受食管癌质子放射治疗的患者情况。收集了人口统计学、临床病理、毒性和剂量测定信息。
我们确定了2010年至2019年间在10家机构接受治疗的155例患者。其中120例（77%）为腺癌，34例（22%）为鳞状细胞癌。137例（88%）接受了同步化疗。中位给予剂量为50.51戈瑞当量（GyE；范围为41.4 - 70.1）。22例（14%）患者出现≥3级毒性反应，最常见的是吞咽困难（6%）、食管炎（4%）、厌食（4%）和恶心（2%）。未出现≥4级淋巴细胞减少事件，也没有5级毒性反应。心脏、肺和肝脏的平均剂量以及脊髓的平均最大剂量分别为10.0 GyE、4.8 GyE、3.8 GyE和34.2 GyE。对于胃食管交界部肿瘤，8%的患者出现急性≥3级毒性反应，心脏、肝脏、右肾和左肾的平均剂量分别为10.5 GyE、3.9 GyE、0.4 GyE和4.9 GyE。在单因素分析（P = 0.0009）和多因素分析（P = 0.004）中，胃食管交界部位置对≥3级毒性反应的发生具有保护作用。
对于接受根治性治疗的食管癌患者，质子束放射治疗具有出色的剂量测定参数和低毒性。正在进行前瞻性试验以研究基于质子治疗的比较获益。
