Proton therapy in esophageal cancerDosimetric comparison to the heart and cardiac substructure in a large cohort of esophageal cancer patients treated with proton beam therapy or Intensity-modulated radiation therapy
Section snippets
Patients
The appropriate institutional review board approved the study. We searched a clinical database of esophageal cancer patients to identify those who received RT with or without surgical resection at our institution between March 2004 and December 2015. Inclusion criteria included pathologic confirmation of mid- to distal esophageal cancer, receipt of chemoradiation therapy using IMRT or PBT with curative intent, completion of a radiation dose of 50.4 Gy or 50.4 cobalt Gray equivalents in 28
Results
A total of 727 patients met the study criteria, including 477 who received IMRT and 250 who received PBT. The patient, tumor, and treatment characteristics are summarized in Table 1. Of the 250 patients who received PBT, 13 received IMPT.
Discussion
To our knowledge, the present study is the first to compare detailed dose distribution to the coronary arteries and chambers of the heart between IMRT and PBT in esophageal cancer patients. Our findings show that compared with IMRT, PBT improved the sparing of normal cardiac structures at almost every dose level. These findings support the use of PBT rather than IMRT in esophageal cancer patients with tumors in the mid- or distal esophagus. The findings of the present study improve our
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of interest
SHL has research funding from Elekta, STCube Pharmaceuticals, Peregrine Pharmaceuticals, Hitachi Chemical Inc., and Roche/Genentech, has served as consultant for AstraZeneca. All other authors have no conflicts of interest to declare.
Acknowledgments
The authors would like to thank Joseph Munch from the Department of Scientific Publication, The University of Texas MD Anderson Cancer Center, for reviewing the manuscript.
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