title: Clinical results of proton beam therapy for twenty older patients with esophageal cancer.
abstract: BACKGROUND
  In an aging society, increasing number of older patients are diagnosed with esophageal cancer. The purpose of this study was to assess the clinical efficacy and safety of proton beam therapy for older patients with esophageal cancer.
  
  
  METHODS
  Older patients (age: ≥ 65 years) newly diagnosed with esophageal cancer between January 2009 and June 2013 were enrolled in this study. All patients underwent either proton beam therapy alone or proton beam therapy with initial X-ray irradiation. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0.
  
  
  RESULTS
  Twenty patients were eligible for this study and all completed the treatment. The median age was 78 years (range: 65-89 years) and the median follow-up time was 26.5 months (range: 6-62 months). Seven patients had lymph node metastases and 10 had stage II/III cancer. The median dose of proton beam therapy was 72.6 Gy relative biological dose effectiveness (RBE) (range: 66-74.8 Gy [RBE]) for proton beam therapy alone and 33 Gy (RBE) (range: 30.8-39.6 Gy [RBE]; total dose range: 66.8-75.6 Gy [RBE]) for proton beam therapy with initial X-ray irradiation. The 2-year overall survival rate was 81.8% (95% confidence interval [CI]: 62.4%-100%), and the 2-year local control rate was 89.4% (95% CI: 75.5%-100%). Grade 2 or 3 toxicities occurred in some cases; however, no grade 4 or 5 toxicity was observed.
  
  
  CONCLUSIONS
  High-dose (66-75.6 Gy [RBE]) proton beam therapy without chemotherapy was an efficacious and safe treatment for older patients with esophageal cancer.
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ono
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Azami
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamaguchi
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.
authors.forename: Motohisa
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.
authors.forename: Yoshiomi
authors.initials: Y
authors.lastname: Hatayama
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Tsukiyama
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Hareyama
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: Department of Radiation Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nemoto
keywords: aged; esophageal neoplasms; proton therapy; radiotherapy
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