Proton beam therapy for esophageal cancer compared to existing treatments, including X-ray therapy and surgery

Abstract

Esophageal cancer is one of the most difficult cancers to treat since it is often at an advanced stage at the time of symptom presentation. For locally advanced esophageal cancer, treatment options include multidisciplinary treatment such as surgery or definitive chemoradiotherapy. Surgery has a high local control rate because it involves excision of the cancer along with the surrounding organs; however, it is still highly invasive, although advances in surgery have reduced the burden on patients. On the other hand, chemoradiotherapy may also be applicable in cases in which surgery is inoperable owing to complications or distant lymph node metastasis. However, chemoradiotherapy using X-ray irradiation can cause late toxicities, including those to the heart. Proton beam therapy is widely used to treat esophageal cancer because of its characteristics, and some comparisons between proton beam therapy and X-ray therapy or surgery have recently been reported. This review discusses the role of proton beam therapy in esophageal cancer in comparison to X-ray therapy and surgery.

Keywords: Esophageal neoplasms; Prognosis; Proton beam therapy; Chemoradiotherapy; X-ray therapy; Esophagectomy; Toxicity; Quality of life; Dose volume histogram

Core Tip: Despite medical advances, esophageal cancer has a poor prognosis. Recently, there have been many reports on proton beam therapy combined with chemotherapy. Compared to X-ray therapy, proton beam therapy can reduce toxicity and may lead to long-term survival while maintaining the quality of life. Some reports suggest that it may be possible to achieve results comparable to those of surgery, although this is premised on an environment in which appropriate post-recurrence treatment can be performed. Proton beam therapy plays a significant role in the treatment of esophageal cancer in an aging society.