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Novel Radiation Therapy Techniques Should Become Standard in Esophageal Cancer Management

Shannon Connelly
Published: Monday, Apr 17, 2017

Steven H. Lin, MD, PhD

Steven H. Lin, MD, PhD

Technological advancements in the radiation therapy field, including intensity-modulated radiation therapy (IMRT) and proton therapy, have become a novel and more concentrated approach to delivering radiation doses as well as spare patients from life-threatening toxicities. This direction differs from 3D conformal radiation therapy, which remains the current standard of care for radiation therapy delivery, even with its long-term morbidity and mortality risks.

, Steven H. Lin, MD, PhD, associate professor of radiation oncology, The University of Texas MD Anderson Cancer Center, discussed why IMRT should be adopted as the new standard approach. He also hones in on the benefits of these advanced radiation technologies, specifically for patients with esophageal cancer.

OncLive: Can you give an overview of your talk on advances in radiation therapy?

Lin: In esophageal cancer management, the most important thing in terms of treatment modality is radiation, along with surgery and chemotherapy. Surgery is still reserved for early-stage cancers; however, for locally advanced diseases, pre-operative chemoradiation followed by surgery is now the current standard of care in patients who are surgical candidates.

Proton therapy is the next most advanced, because it’s not actually x-rays, it’s charged particles, the protons are hydrogen ions that are accelerated and delivered into the patient. By the physical property of charged particles and its interaction with matter, it delivers energy at a very specific point and not beyond that point. Because of the physical nature of protons, it completely spares the surrounding structures while delivering the high dose to the tumor, and relatively no doses are delivered to parts of the heart and lung compared to even IMRT.

What data was looked at in the analysis you performed?

We looked at our experience and compared our complications after surgery and long-term outcomes of patients who were treated between 3-D conformal and IMRT. We found that the use of IMRT does seem to improve and reduce toxicities that patients experience in the immediate surgical period in terms of the incidence of pulmonary complications and gastrointestinal complications, but also long-term outcomes, including cardiac mortality, seem to be spared with the use of IMRT.
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