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Proton Radiotherapy Significantly Reduces Pneumonia in Patients With Esophageal Cancer.

Mark L Frederiks1, Boudewijn van Etten2, Wendy Kelder3

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Summary
This summary is machine-generated.

Proton radiation therapy (PRT) significantly lowers pneumonia rates after neoadjuvant chemoradiation (nCRT) for esophageal cancer (EC) compared to photon radiation therapy (PhRT). This reduction is linked to lower mean radiation doses and less irradiated lung/heart volume.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Neoadjuvant chemoradiation (nCRT) followed by surgery is standard for esophageal cancer (EC).
  • Pneumonia is a common complication of nCRT for EC.
  • Proton radiation therapy (PRT) may reduce treatment-related toxicity compared to photon radiation therapy (PhRT).

Purpose of the Study:

  • To compare the incidence of pneumonia after PRT versus PhRT in EC patients undergoing nCRT and esophagectomy.
  • To investigate the relationship between radiation dose parameters and pneumonia development.

Main Methods:

  • Prospective cohort analysis of 313 EC patients treated with nCRT (PRT or PhRT) and esophagectomy.
  • Multivariable logistic regression to assess the impact of RT technique on pneumonia incidence.
  • Principal component analysis (PCA) of lung and heart dose-volume histogram parameters to identify dose-effect relationships.

Main Results:

  • Pneumonia occurred in 28% of patients, with lower rates after PRT (12%) versus PhRT (32%) (P < .01).
  • PRT significantly reduced pneumonia risk (OR, 0.33; P = .01), independent of surgical approach and planning target volume.
  • PCA identified key dose-related factors (PC1: mean heart/lung dose; PC3: low-dose lung/heart volume) associated with pneumonia. PRT showed lower values for these PCs.

Conclusions:

  • PRT significantly decreases pneumonia incidence compared to PhRT in EC patients receiving nCRT and esophagectomy.
  • The benefit of PRT is associated with reduced mean radiation dose and less irradiated volume to the lungs and heart.