title: Improving Outcomes for Esophageal Cancer using Proton Beam Therapy.
abstract: Radiation therapy (RT) plays an essential role in the management of esophageal cancer. Because the esophagus is a centrally located thoracic structure there is a need to balance the delivery of appropriately high dose to the target while minimizing dose to nearby critical structures. Radiation dose received by these critical structures, especially the heart and lungs, may lead to clinically significant toxicities, including pneumonitis, pericarditis, and myocardial infarction. Although technological advancements in photon RT delivery like intensity modulated RT have decreased the risk of such toxicities, a growing body of evidence indicates that further risk reductions are achieved with proton beam therapy (PBT). Herein we review the published dosimetric and clinical PBT literature for esophageal cancer, including motion management considerations, the potential for reirradiation, radiation dose escalation, and ongoing esophageal PBT clinical trials. We also consider the potential cost-effectiveness of PBT relative to photon RT.
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Chuong
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Hallemeier
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
authors.forename: Salma K
authors.initials: SK
authors.lastname: Jabbour
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Jen
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Shahed
authors.initials: S
authors.lastname: Badiyan
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Merrell
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Mishra
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Heng
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Vivek
authors.initials: V
authors.lastname: Verma
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas. Electronic address: shlin@mdanderson.org.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Lin
mesh_terms: D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000532:radiotherapy*; D004947:Esophagus / Q000528:radiation effects; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008168:Lung / Q000528:radiation effects; D009068:Movement; D058958:Organs at Risk / Q000528:radiation effects; D017785:Photons / Q000627:therapeutic use; D061766:Proton Therapy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D000069475:Re-Irradiation; D012062:Relative Biological Effectiveness; D012542:Scattering, Radiation; D016896:Treatment Outcome