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

Purpose: 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. Experimental Design: 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. Results: 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. Conclusions: 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.