Comparing 90-Day Postoperative Mortality After Neoadjuvant Proton-Based Versus Photon-Based Chemoradiotherapy for Esophageal Cancer

• Published in: International journal of particle therapy 2024-03, Vol.11, p.100012-100012, Article 100012
• Main Authors: Damen, Pim J.J., van Rossum, Peter S.N., Chen, Yiqing, Abana, Chike O., Liao, Zhongxing, Hobbs, Brian P., Mohan, Radhe, Blum-Murphy, Mariela, Hofstetter, Wayne L., Lin, Steven H.
• Format: Article
• Language: English
• Subjects: 90-day mortality; Chemoradiation; Esophageal cancer; Esophagectomy; Original; Proton-beam therapy
• ISSN: 2331-5180; 2331-5180
• DOI: 10.1016/j.ijpt.2024.100012

Evidence suggests that proton-beam therapy (PBT) results in less toxicity and postoperative complications compared to photon-based radiotherapy in patients who receive chemoradiotherapy followed by esophagectomy for cancer. Ninety-day mortality (90DM) is an important measure of the postoperative (nononcologic) outcome as proxy of quality-of-care. We hypothesize that PBT could reduce 90DM compared to photon-based radiotherapy. From a single-center retrospective database patients treated with chemoradiotherapy before esophagectomy for cancer were selected (1998-2022). Univariable logistic regression was used to study the association of radiotherapy modality with 90DM. Three separate methods were applied to adjust for confounding bias, including multivariable logistic regression, propensity score matching, and inverse probability of treatment weighting. Stratified analysis for the age threshold that maximized the difference in 90DM (ie, ≥67 vs