Cristina M DeCesaris1, Rachel McCarroll2, Mark V Mishra3, Erica Glass4, Bruce D Greenwald5, Shamus Carr4, Whitney Burrows4, Ranee Mehra6, William F Regine3, Charles B Simone7, J Isabelle Choi7, Jason K Molitoris3. 1. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland. Electronic address: cristina.decesaris@umm.edu. 2. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland. 3. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland. 4. Department of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 5. Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland. 6. Department of Medical Oncology, University of Maryland School of Medicine, Baltimore, Maryland. 7. New York Proton Center, New York, New York.
Abstract
INTRODUCTION: Re-irradiation (re-RT) for locoregionally recurrent esophageal and gastroesophageal junction (GEJ) cancer and de novo esophageal + GEJ cancer arising in-field after a course of prior radiation poses considerable treatment challenges given the sensitivity of surrounding organs at risk (OARs). Guidelines for treatment of this presentation are not well established. Pencil-beam scanning (PBS) proton therapy has the ability to decrease radiation dose to OARs relative to photon plans. We present the first published series to date of re-RT with PBS for esophageal + GEJ malignancies and hypothesize that re-RT with proton PBS will be feasible and improve the safety profile of re-RT for this cohort of patients. METHODS: Consecutive esophageal + GEJ cancers treated with PBS re-RT within a single institution were analyzed. Comparative volumetric-modulated arc therapy photon plans were generated. A total of 17 patients were included for analysis. RESULTS: At a median follow-up of 11.6 months, 1-year local control was 75.3% and overall survival was 68.9%. There were five (27.8%) grade 3 or higher late toxicities. When matched for clinical target volume coverage, proton PBS plans delivered significantly lower doses to the spinal cord, lungs, liver, and heart (all p < 0.05); five volumetric-modulated arc therapy plans would have been undeliverable on the basis of physician-specified OAR constraints. CONCLUSIONS: Re-RT for de novo or recurrent malignancies of the esophagus + GEJ, when delivered with PBS proton therapy, yields high rates of local control with acceptable acute and late toxicities in a high-risk population and decreased radiation dose to OARs relative to comparative photon plans. This is the largest series of proton re-RT for esophageal malignancies and the first that exclusively used PBS.
INTRODUCTION: Re-irradiation (re-RT) for locoregionally recurrent esophageal and gastroesophageal junction (GEJ) cancer and de novo esophageal + GEJ cancer arising in-field after a course of prior radiation poses considerable treatment challenges given the sensitivity of surrounding organs at risk (OARs). Guidelines for treatment of this presentation are not well established. Pencil-beam scanning (PBS) proton therapy has the ability to decrease radiation dose to OARs relative to photon plans. We present the first published series to date of re-RT with PBS for esophageal + GEJ malignancies and hypothesize that re-RT with proton PBS will be feasible and improve the safety profile of re-RT for this cohort of patients. METHODS: Consecutive esophageal + GEJ cancers treated with PBS re-RT within a single institution were analyzed. Comparative volumetric-modulated arc therapy photon plans were generated. A total of 17 patients were included for analysis. RESULTS: At a median follow-up of 11.6 months, 1-year local control was 75.3% and overall survival was 68.9%. There were five (27.8%) grade 3 or higher late toxicities. When matched for clinical target volume coverage, proton PBS plans delivered significantly lower doses to the spinal cord, lungs, liver, and heart (all p < 0.05); five volumetric-modulated arc therapy plans would have been undeliverable on the basis of physician-specified OAR constraints. CONCLUSIONS: Re-RT for de novo or recurrent malignancies of the esophagus + GEJ, when delivered with PBS proton therapy, yields high rates of local control with acceptable acute and late toxicities in a high-risk population and decreased radiation dose to OARs relative to comparative photon plans. This is the largest series of proton re-RT for esophageal malignancies and the first that exclusively used PBS.
Authors: Jana M Kobeissi; Charles B Simone; Lara Hilal; Abraham J Wu; Haibo Lin; Christopher H Crane; Carla Hajj Journal: Cancers (Basel) Date: 2022-06-10 Impact factor: 6.575
Authors: Michael D Chuong; Christopher L Hallemeier; Heng Li; Xiaorong Ronald Zhu; Xiaodong Zhang; Erik J Tryggestad; Jen Yu; Ming Yang; J Isabelle Choi; Minglei Kang; Wei Liu; Antje Knopf; Arturs Meijers; Jason K Molitoris; Smith Apisarnthanarax; Huan Giap; Bradford S Hoppe; Percy Lee; Joe Y Chang; Charles B Simone; Steven H Lin Journal: Front Oncol Date: 2021-10-19 Impact factor: 6.244