Comparative Effectiveness of Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiotherapy for Inoperable Esophageal Squamous Cell Carcinoma Patients Undergoing Curative-Intent Concurrent Chemoradiotherapy
Menée à l'aide de données 2015-2020 portant sur 10 893 patients atteints d'un carcinome épidermoïde de l'oesophage inopérable, cette étude compare l'efficacité d'une chimiothérapie à base de platine associée d'une part à une radiothérapie avec modulation d'intensité et d'autre part à une protonthérapie à intensité modulée
Background: This study compared outcomes in inoperable esophageal squamous cell carcinoma (ESCC) patients undergoing curative-intent concurrent chemoradiotherapy (CCRT) with intensity-modulated radiotherapy (IMRT) versus intensity-modulated proton therapy (IMPT). Methods: The study encompassed a retrospective cohort analysis of inoperable ESCC patients who underwent curative-intent CCRT from January 1, 2015, to December 31, 2020, with data sourced from the Taiwan Cancer Registry Database. In this study, both IMRT and IMPT delivered a total dose of approximately 5040 cGy in 28 fractions, accompanied by platinum-based chemotherapy administered as per established protocols. Multivariate Cox regression analyses were performed to assess oncologic outcomes, and statistical analyses were conducted, including inverse probability of treatment-weighted and Fine and Gray method for competing risks. Results: The observed risks of ESCC-specific and all-cause mortality were lower in patients treated with IMPT compared to those treated with IMRT, with adjusted hazard ratios (aHRs) of 0.62 (95% CI: 0.58, 0.70) and 0.72 (95% CI: 0.66, 0.80), respectively. IMPT also reduced Grade 2 radiation-induced side effects, such as pneumonitis, fatigue, and MACE, with aHRs (95% CI) of 0.76 (0.66, 0.82), 0.10 (0.07, 0.14), and 0.70 (0.67, 0.73). However, IMPT was associated with an increased risk of Grade 2 radiation dermatitis, aHR (95% CI) of 1.48 (1.36, 1.60). No significant differences were found in the incidence of radiation esophagitis between IMPT and IMRT when adjusting for covariates. Conclusion: IMPT appears to be associated with superiority over IMRT in managing inoperable ESCC patients undergoing curative-intent CCRT, suggesting improved survival outcomes and reduced toxicity. These findings have significant implications for the treatment of ESCC, particularly when surgery is not an option.