Proton beam therapy poses lower risk for older esophageal cancer patients

Volume 7, Issue 1, 2018


Death rates and heart and lung problems were higher with standard treatments, researchers found.

Scott C. Lester, M.D.

Scott C. Lester, M.D.

When treating older patients with esophageal cancer, combining proton beam therapy with chemotherapy before surgery may be a better option than combining traditional radiation therapy techniques with chemotherapy, a Mayo Clinic research study shows.

"Elderly patients experience more post-treatment heart and lung problems and are at higher risk of death after surgery than are younger patients after receiving a combination of preoperative chemotherapy and radiation therapy," said Scott C. Lester, M.D., a radiation oncologist at the Mayo Clinic campus in Rochester, Minnesota.

The research study found that patients with esophageal cancer who were treated with proton beam therapy experienced lower rates of death and postoperative heart and lung problems, such as acute respiratory distress syndrome.

Standard X-ray radiation therapy techniques include 3-D conformal radiation and intensity-modulated radiation therapy (IMRT).

For the esophageal cancer study, researchers followed 571 patients treated with traditional radiation therapy and chemotherapy followed by surgery at the Mayo Clinic Cancer Center, MD Anderson Cancer Center, and the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center from 2007 to 2013.

Thirty-five percent of patients were age 65 or older at diagnosis and classified as "elderly" for the study. Forty-three percent of the these patients received 3-D conformal radiation, 36 percent of patients received intensity-modulated radiation, and 21 percent received proton beam therapy.

The researchers analyzed and compared outcomes by the type of radiation treatment. They found that these older patients treated with proton beam therapy had lower rates of heart and lung problems after surgery and a lower postoperative mortality rate than did patients treated with standard techniques.

None of the patients treated with proton beam therapy experienced a postoperative death, which the researchers think is partially related to the ability to reduce the radiation dose to important structures near the esophagus, such as the heart and lungs, with proton beam therapy.

"Age itself should not be a disqualifying factor for aggressive cancer treatment, but efforts to minimize the side effects of treatment are especially important in the elderly," Dr. Lester said. "This study showed that advanced radiation techniques, especially proton beam therapy, can help improve outcomes in this population and may allow for more patients 65 years and older to undergo aggressive treatment for their esophagus cancer."