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Abstract
Background: Proton beam therapy (PBT), as a neoadjuvant chemoradiotherapy (nCRT) modality, is expected to result in better outcomes than photon-based radiotherapy (RT) for esophageal cancer, particularly adenocarcinoma. This study reports the results of nCRT for locally advanced esophageal squamous cell carcinoma (ESCC) using both modalities.

Methods: We retrospectively reviewed the records of patients who underwent nCRT for ESCC between 2001 and 2020. A median of 41.4 Gy or cobalt gray equivalents of radiation was delivered using either photons or protons, with concurrent chemotherapy. Dosimetric and clinical parameters were compared between the two groups.

Results: Of the 31 patients, the lungs and heart of the proton group (n = 15) were exposed to significantly less radiation compared to the photon group (n = 16). No significant differences in short-term postoperative outcomes or lymphocyte count were observed between the groups, and there were no significant differences between the photon and proton groups in 2-year overall survival (67.8% vs. 68.6%, p = 0.867) or 2-year disease-free survival (33.3% vs. 34.5%, p = 0.749), with a median follow-up of 17 months.

Conclusions: PBT provided a significant dosimetric benefit over photon-based RT during nCRT for ESCC; however, it did not improve clinical outcomes.

Affiliations

Jin-Ho Choi  1 , Jong Mog Lee  1 , Moon Soo Kim  1 , Youngjoo Lee  2 , Yang-Gun Suh  3 , Sung Uk Lee  3 , Doo Yeul Lee  3 , Eun Sang Oh  3 , Tae Hyun Kim  3 , Sung Ho Moon  3
1 Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea.
2 Department of Internal Medicine, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea.
3 Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea.