Retrospective cohort study of IMPT versus IMRT in concurrent chemoradiotherapy for inoperable esophageal squamous cell carcinoma

A retrospective cohort study using the Taiwan Cancer Registry Database compared intensity-modulated proton therapy (IMPT) versus intensity-modulated radiotherapy (IMRT) in patients receiving curative-intent concurrent chemoradiotherapy for inoperable esophageal squamous cell carcinoma (ESCC). Compared with the IMRT group, the IMPT group had better ESCC-specific mortality (aHR 0.62; 95% CI 0.58-0.70), all-cause mortality (0.72; 0.66-0.80) and less grade 2 or higher pneumonitis (0.76; 0.66-0.82), fatigue (0.10; 0.07-0.14), and major adverse cardiovascular events (0.70; 0.67-0.73), but increased risk of radiation dermatitis (1.48; 1.36-1.60). There were no significant differences between the two groups in incidence of radiation esophagitis. The authors conclude that IMPT appears to be associated with superiority over IMRT in managing inoperable ESCC patients undergoing curative-intent concurrent chemoradiotherapy.