A Comparison of Patient-Reported Health-Related Quality of Life During Proton Versus Photon Chemoradiation Therapy for Esophageal Cancer

Aurelie Garant, Thomas J. Whitaker, Grant M. Spears, David M. Routman, William S. Harmsen, Tyler J. Wilhite, Jonathan B. Ashman, Terence T. Sio, William G. Rule, Michelle A. Neben Wittich, James A. Martenson, Erik J. Tryggestad, Harry H. Yoon, Shanda Blackmon, Kenneth W. Merrell, Michael G. Haddock, Christopher L. Hallemeier

Research output: Contribution to journalArticle


Purpose: The purpose of this study was to compare Functional Assessment of Cancer Therapy-Esophagus (FACT-E) questionnaire changes during proton (PRT) or photon (XRT) chemoradiation therapy (CRT) for esophageal cancer (EC). Methods and Materials: We reviewed patients enrolled in a prospective registry who received preoperative or definitive CRT for EC. Patients completed the FACT-E before CRT and during the last week of CRT. Analysis of variance testing was used to assess associations between patient and treatment characteristics and FACT-E score changes. Results: One hundred twenty-five patients completed a baseline and posttreatment FACT-E; 63 received XRT and 62 received PRT. The mean age was 65 years; the PRT group was older (68 vs 64 years, P = .0063). The following characteristics were similar between cohorts: 83% male, 78% adenocarcinoma, and 89% stage II-III. The radiation therapy prescription dose was higher in the PRT group (≥50 Gy in 94% vs 67%, P < .0001), whereas the median clinical target volume was smaller in the PRT group (553 vs 668 cm3, P = .013). Most (96%) received concurrent weekly carboplatin-paclitaxel. The mean FACT-E score was 136.3 (standard deviation [SD] 21.0) at baseline and 119.6 (SD 24.8) post-CRT, with mean change of –16.7 (SD 19.8). Baseline scores were comparable between XRT and PRT groups (135.9 vs 136.7, P = .82). On univariate and multivariate analyses, less mean decline in FACT-E score was observed for PRT versus XRT (–12.7 vs –20.6, P = .026) and for trimodality versus definitive therapy (–13.0 vs –22.5, P = .008). Conclusions: For patients receiving CRT for EC, PRT was associated with less decline in FACT-E scores compared with XRT.

Original languageEnglish (US)
Pages (from-to)410-417
Number of pages8
JournalPractical Radiation Oncology
Issue number6
Publication statusPublished - Nov 2019
Externally publishedYes


ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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