TY - JOUR
T1 - Comparative Outcomes After Definitive Chemoradiotherapy Using Proton Beam Therapy Versus Intensity Modulated Radiation Therapy for Esophageal Cancer
T2 - A Retrospective, Single-Institutional Analysis
AU - Xi, Mian
AU - Xu, Cai
AU - Liao, Zhongxing
AU - Chang, Joe Y.
AU - Gomez, Daniel R.
AU - Jeter, Melenda
AU - Cox, James D.
AU - Komaki, Ritsuko
AU - Mehran, Reza
AU - Blum, Mariela A.
AU - Hofstetter, Wayne L.
AU - Maru, Dipen M.
AU - Bhutani, Manoop S.
AU - Lee, Jeffrey H.
AU - Weston, Brian
AU - Ajani, Jaffer A.
AU - Lin, Steven H.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Purpose To compare clinical outcomes between proton beam therapy (PBT) and intensity modulated radiation therapy (IMRT) in patients with esophageal cancer (EC) treated with definitive chemoradiotherapy (CRT). Methods and Materials From 2007 through 2014, 343 EC patients who received definitive CRT with either PBT (n=132) or IMRT (n=211) were retrospectively analyzed. Survival, recurrence, and treatment toxicity were compared between groups. A Cox proportional hazards regression model was performed to test the association between patient/treatment variables and survival. Results Patient/treatment variables were overall well balanced, except for age and race. Compared with IMRT, PBT had significantly better overall survival (OS; P=.011), progression-free survival (PFS; P=.001), distant metastasis–free survival (DMFS; P=.031), as well as marginally better locoregional failure–free survival (LRFFS; P=.075). No significant differences in rates of treatment-related toxicities were observed between groups. On multivariate analysis, IMRT had worse OS (hazard ratio [HR] 1.454; P=.01), PFS (HR 1.562; P=.001), and LRFFS (HR 1.461; P=.041) than PBT. Subgroup analysis by clinical stage revealed considerably higher 5-year OS (34.6% vs 25.0%, P=.038) and PFS rates (33.5% vs 13.2%, P=.005) in the PBT group for patients with stage III disease. However, no significant intergroup differences in survival were identified for stage I/II patients. Conclusions Compared with IMRT, PBT might be associated with improved OS, PFS, and LRFFS, especially in EC patients with locally advanced disease. These results need confirmation by prospective studies.
AB - Purpose To compare clinical outcomes between proton beam therapy (PBT) and intensity modulated radiation therapy (IMRT) in patients with esophageal cancer (EC) treated with definitive chemoradiotherapy (CRT). Methods and Materials From 2007 through 2014, 343 EC patients who received definitive CRT with either PBT (n=132) or IMRT (n=211) were retrospectively analyzed. Survival, recurrence, and treatment toxicity were compared between groups. A Cox proportional hazards regression model was performed to test the association between patient/treatment variables and survival. Results Patient/treatment variables were overall well balanced, except for age and race. Compared with IMRT, PBT had significantly better overall survival (OS; P=.011), progression-free survival (PFS; P=.001), distant metastasis–free survival (DMFS; P=.031), as well as marginally better locoregional failure–free survival (LRFFS; P=.075). No significant differences in rates of treatment-related toxicities were observed between groups. On multivariate analysis, IMRT had worse OS (hazard ratio [HR] 1.454; P=.01), PFS (HR 1.562; P=.001), and LRFFS (HR 1.461; P=.041) than PBT. Subgroup analysis by clinical stage revealed considerably higher 5-year OS (34.6% vs 25.0%, P=.038) and PFS rates (33.5% vs 13.2%, P=.005) in the PBT group for patients with stage III disease. However, no significant intergroup differences in survival were identified for stage I/II patients. Conclusions Compared with IMRT, PBT might be associated with improved OS, PFS, and LRFFS, especially in EC patients with locally advanced disease. These results need confirmation by prospective studies.
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U2 - 10.1016/j.ijrobp.2017.06.2450
DO - 10.1016/j.ijrobp.2017.06.2450
M3 - Article
C2 - 29280461
AN - SCOPUS:85031725060
SN - 0360-3016
VL - 99
SP - 667
EP - 676
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 3
ER -