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Radiation Oncology • Gastrointestinal Cancers
What proton dose regimen would you use for locally recurrent esophageal cancer previously treated with chemoRT?
For a patient with an access to proton beam therapy, what dose regimen would you use in the context of a locally recurrent esophageal cancer, previously treated with combined modality treatment with RT dose in the range 45-50.4 Gy?
Answer from: Radiation Oncologist at Academic Institution
Like @William M. Mendenhall, I would also somewhat challenge the premise of the question. Typically, the dose-limiting structure for re-irradiating esophageal cancer is the esophagus itself, so protons do not offer an inherent advantage in this case. Protons may still be reasonable to reduce lung or...
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Answer from: Radiation Oncologist at Community Practice
There are several varying clinical scenarios that this question can represent, including:1) A recurrence after trimodality therapy, with gross disease present a significant distance from the surgical anastomosis, in tissue that was previously unirradiated.2) A recurrence after trimodality therapy wi...
Answer from: Radiation Oncologist at Academic Institution
Palliatively. Not a good use of protons.
Answer from: Radiation Oncologist at Community Practice
For patients who are not operative candidates, who relapse after chemo-RT, at our center, we have re-treated with 45 Gy chemo-RT using pencil-beam scanning proton therapy and CBCT guidance. The margins are pretty narrow, no elective nodal coverage, and typically follows a prior dose of 50.4 Gy with ...