Proton therapy for gastrointestinal malignancy

Proton therapy for gastrointestinal malignancy

Proton therapy for gastrointestinal malignancy

Proton therapy can significantly reduce radiation exposure to organs at risk and healthy tissues which offers potential to reduce radiation-induced toxicities. There is a growing collection of clinical studies suggesting that proton therapy is effective for GI cancer patients, and may also improve the toxicity profile. This white paper aims to provide existing clinical data when considering treatment options that benefit patients the most.

What can you gain?

The improved dosimetry with proton therapy enables greater sparing of normal tissues and greater reduction in integral dose. This translates to the potential ability of escalating dose in the tumor while maintaining low toxicity, which may improve the therapeutic ratio of radiation treatment.

An increasing amount of data reported has shown that proton therapy has great potential to increase therapeutic tolerance for patients with GI malignancies. The possibility of decreasing radiation dose to organs at risk may also help facilitate chemotherapy dose escalation or allow for new chemotherapy combinations.

Proton therapy will play a decisive role in the context of ongoing intensified combined modality treatments for GI cancers. The following review presents the benefits of proton therapy in treating hepatocellular carcinoma, pancreatic cancer and esophageal cancer.

Reference to ongoing studies

Liver cancer

There are nine studies registered on the ClinicalTrials.gov registry and results database investigating proton therapy for liver cancer, including eight on HCC and one about liver metastasis. In addition to phase II studies looking into efficacy and toxicity, there are four randomized comparison trials.
Pancreatic cancer
There are eight trials registered with ClinicalTrials.gov investigating proton therapy combined with chemotherapy in treating pancreatic cancer. University of Florida leads three studies looking into protons plus chemotherapy for resectable, unresectable and postoperative pancreatic cancer. Massachusetts General Hospital (MGH) has three efficacy studies looking into proton therapy combined with different chemo-agents. A University of Pennsylvania study is investigating dose escalation in both a novel chemotherapy agent and radiation dose for locally advanced pancreatic cancer.
The expert's perspective
John Plastaras, M.D., Ph.D. is an Associate Professor in the Department of Radiation Oncology at the Perelman School of Medicine of the University of Pennsylvania. He is the Chief of the Lymphoma and Gastrointestinal Cancer
Service says: “In particular, liver tumors, pancreas, and esophagus cancers are common disease sites where practitioners are especially concerned by the toxicity of radiation and will use whatever tools exist to allow treatment without excessive side effects. However proton therapy is also used for other GI sites in select cases, such as anorectal cancers, cholangiocarcinomas, duodenal cancers, and gastric cancer.”

 

Useful documents, white papers and publications

Learn more about the benefits of proton therapy  and find the latest studies in this IBA white paper.

IBA White paper: Treating gastrointestinal malignancy with proton therapy

General overview of the current practice, opportunities and challenges in gastrointestinal malignancy treatment