Photon Versus Proton Beam Therapy for T1-3 Squamous Cell Carcinoma of the Thoracic Esophagus Without Lymph Node Metastasis

Yang-Gun Suh; Unurjargal Bayasgalan; Heung Tae Kim; Jong Mog Lee; Moon Soo Kim; Youngjoo Lee; Doo Yeul Lee; Sung Uk Lee; Tae Hyun Kim; Sung Ho Moon

doi:10.3389/fonc.2021.699172

Photon Versus Proton Beam Therapy for T1-3 Squamous Cell Carcinoma of the Thoracic Esophagus Without Lymph Node Metastasis

Front Oncol. 2021 Jun 21:11:699172. doi: 10.3389/fonc.2021.699172. eCollection 2021.

Authors

Affiliations

¹ Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
² Department of Radiation Oncology, National Cancer Center, Ulaanbaatar, Mongolia.
³ Department of Internal Medicine, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
⁴ Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.

Abstract

Background and purpose: We compared treatment outcomes and toxicities of photon radiotherapy versus proton beam therapy (PBT) and evaluated radiation field effects for T1-3 squamous cell carcinoma of the thoracic esophagus (EC) without lymph node metastasis.

Methods: Medical records of 77 patients with T1-3N0M0 thoracic EC treated with radiotherapy between 2011 and 2019 were retrospectively analyzed. Among these patients, 61 (79.2%) individuals had T1 EC. The initial clinical target volume encompassed the whole esophagus with or without supraclavicular and/or abdominal lymph nodes (extended-field radiotherapy; 67 patients, 87.0%) or the area 3-5 cm craniocaudally and 1-2 cm radially from the gross tumor volume (involved-field radiotherapy; 10 patients, 13.0%). The final clinical target volume included margins of at least 1 cm from the gross tumor volume, with total radiation doses of 50-66 (median, 66) cobalt gray equivalent. Three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and PBT were used in twenty-four, five, and forty-eight patients, respectively. Concurrent chemotherapy was administered to 17 (22.0%) patients overall and only five (8.0%) T1 patients.

Results: PBT showed significantly lower lung and heart radiation exposure in mean dose, V5, V10, V20, and V30 than photon radiotherapy. The median follow-up for all patients was 46 (interquartile range, 22-72) months. The 5-year progression-free survival and overall survival rates were 56.5 and 64.9%, respectively, with no significant survival difference between photon radiotherapy and PBT. In patients with T1 EC, 5-year progression-free survival and overall survival rates were 62.6 and 73.5%, respectively.

Conclusions: Extended-field radiotherapy using modern radiotherapy techniques without chemotherapy showed satisfactory clinical outcomes for lymph node-negative T1 EC.

Keywords: 3-dimensional radiotherapy; endoscopic submucosal dissection; esophageal cancer; intensity-modulated radiotherapy; lymph node metastasis; organs at risk; proton beam therapy.