TY - JOUR
T1 - Proton beam radiotherapy for esophageal cancer
T2 - challenges and opportunities in the modern era
AU - Verma, Vivek
AU - Lin, Steven H.
N1 - Funding Information:
This has never been presented or published before in any form. S.H.L. has research funding from STCube Pharmaceuticals, Nektar Therapeutics, and Beyond Spring Pharmaceuticals; has served as a consultant for AstraZeneca; is co‐founder and scientific advisor to Scenexo, Inc; and received honorarium from Varian Medical Systems, AstraZeneca. All other authors declare no conflics of interest.
Publisher Copyright:
© 2022 The Authors. Precision Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Shandong Cancer Hospital & Institute.
PY - 2022/9
Y1 - 2022/9
N2 - As the NRG GI006 and PROTECT trials seek to confirm results of the first randomized trial supporting the utility of proton beam therapy for esophageal cancer, several outstanding questions are discussed in this review. First, the applicability/extrapolation of the existing randomized trial is mentioned. This includes a potentially larger benefit of PBT at non-high-volume centers with less surgical expertise, along with the emerging use of active scanning PBT approaches that could further improve toxicity profiles. Patient selection for PBT is then discussed, including differential utility for patients based on the degree of baseline comorbidities, the extent/location of disease, and the surgical case volume at the treating institution. PBT in the setting of emerging techniques, such as minimally invasive esophagectomy, is also mentioned. Next, costs of PBT and insurance coverage hurdles are described, especially regarding pre-specified agreements between providers/institutions and payors, the need for cost-effectiveness analyses for PBT in this population, and effects of the new radiation oncology alternative payment model. Finally, immunotherapy has now become a standard option for esophageal cancer (resected or unresected/recurrent/metastatic cases). Therefore, in the context of immunotherapy for these patients, revisiting the role of radiation dose-escalation and elective nodal irradiation may be required.
AB - As the NRG GI006 and PROTECT trials seek to confirm results of the first randomized trial supporting the utility of proton beam therapy for esophageal cancer, several outstanding questions are discussed in this review. First, the applicability/extrapolation of the existing randomized trial is mentioned. This includes a potentially larger benefit of PBT at non-high-volume centers with less surgical expertise, along with the emerging use of active scanning PBT approaches that could further improve toxicity profiles. Patient selection for PBT is then discussed, including differential utility for patients based on the degree of baseline comorbidities, the extent/location of disease, and the surgical case volume at the treating institution. PBT in the setting of emerging techniques, such as minimally invasive esophagectomy, is also mentioned. Next, costs of PBT and insurance coverage hurdles are described, especially regarding pre-specified agreements between providers/institutions and payors, the need for cost-effectiveness analyses for PBT in this population, and effects of the new radiation oncology alternative payment model. Finally, immunotherapy has now become a standard option for esophageal cancer (resected or unresected/recurrent/metastatic cases). Therefore, in the context of immunotherapy for these patients, revisiting the role of radiation dose-escalation and elective nodal irradiation may be required.
KW - esophageal cancer
KW - proton beam therapy
KW - radiation therapy
UR - http://www.scopus.com/inward/record.url?scp=85131164928&partnerID=8YFLogxK
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U2 - 10.1002/pro6.1162
DO - 10.1002/pro6.1162
M3 - Review article
AN - SCOPUS:85131164928
SN - 2398-7324
VL - 6
SP - 257
EP - 261
JO - Precision Radiation Oncology
JF - Precision Radiation Oncology
IS - 3
ER -