Executive Summary of Clinical and Technical Guidelines for Esophageal Cancer Proton Beam Therapy From the Particle Therapy Co-Operative Group Thoracic and Gastrointestinal Subcommittees

Abstract

Radiation therapy (RT) is an integral component of potentially curative management of esophageal cancer (EC). However, RT can cause significant acute and late morbidity due to excess radiation exposure to nearby critical organs, especially the heart and lungs. Sparing these organs from both low and high radiation dose has been demonstrated to achieve clinically meaningful reductions in toxicity and may improve long-term survival. Accruing dosimetry and clinical evidence support the consideration of proton beam therapy (PBT) for the management of EC. There are critical treatment planning and delivery uncertainties that should be considered when treating EC with PBT, especially as there may be substantial motion-related interplay effects. The Particle Therapy Co-operative Group Thoracic and Gastrointestinal Subcommittees jointly developed guidelines regarding patient selection, treatment planning, clinical trials, and future directions of PBT for EC.

A survey of practice patterns for real-time intrafractional motion-management in particle therapy

“…The PT community is well aware of the importance of RRMM, which has been addressed in recent clinical guidelines [8] , [60] , [61] , [62] and in the annual 4D workshop [4] , [5] , [6] , [7] , [43] Results from POP-ART RT and PT surveys are in line with the recent reports of the 4D workshops [6] , [7] , regarding standardized guidelines to guarantee consistency between protocols applied at different facilities. From this study, we recommend focusing primarily on the development of consensus guidelines for rescanning parameters and inclusion criteria for active RRMM, while technical development and implementation should prioritize direct internal motion monitoring or frequent/practical verification of surrogate accuracy and beam synchronization.…”

Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes

“…Limited data exist on disease control and survival outcomes among patients treated with proton CRT for esophageal cancer (see Table 5 [ 14 , 27 – 30 ]). Altogether, only a few hundred patients with disease control outcomes for proton CRT have been reported in the literature, most of whom come from a single institution [ 31 , 32 ]. As we explore the benefits of proton therapy for toxicity reduction, it is important to ensure that disease control outcomes remain at least equivalent to those observed with photon radiation therapy.…”

“…Owing to the increased sensitivity to organ motion and variations in tissue density associated with the treatment of esophageal cancer, careful attention to beam angles and treatment planning parameters are required to ensure robust proton planning and accurate proton delivery. Numerous strategies have been evaluated and are recommended to achieve effective delivery [ 32 ]. Clinical outcomes data are necessary to confirm the expected results.…”

Beam mask and sliding window‐facilitated deep learning‐based accurate and efficient dose prediction for pencil beam scanning proton therapy

“…Pencil beam scanning proton therapy (PBSPT) is a highly adaptable modern beam delivery technique that reduces the dose to normal tissues as compared to x-ray radiation modalities. [1][2][3][4][5][6][7][8][9][10][11][12][13] PSBPT, however, is more sensitive to range and setup uncertainties in clinical practice as compared to x-ray modalities. [14][15][16][17][18][19][20][21][22] During the fractionated course of treatment using PBSPT, the patient's anatomical structures often change due to weight loss or tumor shrinkage.…”