Proton Beam Therapy for Patients with Esophageal Carcinoma

Fifteen patients with esophageal carcinoma (superficial, sixcases; advanced, nine cases) were treated with 250 MeV protonbeam irradiation with or without external x-ray irradiation(12 MV linear accelerator) from October, 1985, to May, 1991.Eleven patients were initially treated with x-ray at doses of16.2-50.4 (mean 42.5) Gy, followed by proton beam at doses of30.0-52.9 (mean 37.6) Gy. The other four patients were treatedwith proton beam alone at total doses of 75.0-88.5 (mean 81.4)Gy. The mean total dose for the 15 patients was 80.4 Gy. Asa result, the primary tumor lesions of all 15 patients disappearedand complete responses were obtained. Approximately four tofive months later, nine of the 15 patients developed esophagealulcer formations at the circumferences of their primary lesions.The ulcerations were healed, however, by conservative management.There was no evidence of local recurrence throughout the observationson six cases of superficial carcinoma. Among nine advanced carcinomapatients, three relapsed into esophageal carcinoma. Recurrenceswere observed eight, 16 and 44 months, respectively, after thetreatment. Ten of the 15 patients died, but eight died of otherdiseases. Three of four cases at autopsy did not show any cancercells in irradiated primary lesions. Four of the 15 patientslived for over five years. The results suggest that a high doseof irradiation delivered by a well-defined proton field couldresult in improved local control and long-term survival in esophagealcarcinoma without undue risk of injury to primary and adjacentorgans.