Proton beam therapy with high-dose irradiation for superficial and advanced esophageal carcinomas

With the aim of improving the results of treatment for esophageal carcinoma, we have investigated the efficacy and toxicity associated with the use of a 250-MeV proton beam for radical radiation therapy in esophageal carcinoma.

Thirty patients with esophageal carcinoma (superficial, n = 13; advanced, n = 17) had been treated with proton beam therapy alone or with photon therapy followed by proton beam therapy. In combination therapy with photon and proton beams, one fraction dose was 1.8-2.0 Gy for photon and 2.5-3.7 Gy (mean, 3.1 Gy) for proton beam. In proton beam therapy alone, one fraction dose was 3.1-3.6 Gy (mean, 3.2 Gy). Overall mean total doses of the irradiation were 77.7 Gy in superficial carcinoma and 80.7 Gy in advanced carcinoma, respectively.

Mean overall actuarial survival in patients with superficial and advanced carcinomas was 60.1 and 38.6 months, respectively. The local recurrence and disease- specific survival rates for patients with superficial carcinoma were 0 and 100% at 5 years, and 0 and 87.5% at 10 years, respectively; the same rates for the patients with advanced carcinoma were 56.6 and 49.0% at 5 years, 78.3 and 38.1% at 10 years, respectively. Radiation-induced esophageal ulcer without injury of adjacent organs occurred in 20 (66.7%) of 30 treated patients.

Better local control and 5- and 10-year disease-specific survival rates were achieved by a higher dose of irradiation with well-defined proton fields in superficial and advanced esophageal carcinomas.