Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiotherapy for Inoperable Esophageal Squamous Cell Carcinoma: Methodologic Issues

In a recent article published in the Journal of Thoracic Oncology, Chang et al.1 compared the outcomes among patients with inoperable esophageal squamous cell carcinoma (ESCC) who underwent curative concurrent chemoradiotherapy with either intensity-modulated radiotherapy (IMRT) or intensity-modulated proton therapy (IMPT). IMPT significantly lowers ESCC-specific and all-cause mortality and mitigates Radiation Therapy Oncology Group grade greater than or equal to 2 radiation pneumonitis, fatigue, and major adverse cardiovascular events, albeit with a higher radiation dermatitis.