GI cancer, or gastrointestinal cancer, occurs in the GI tract. The GI tract, or digestive system, includes the esophagus, stomach, liver, and pancreas, as well as the small and large intestines, or colon, including the rectum and anus.

Proton therapy for GI cancer can be an excellent treatment option for many types of cancers in the gastrointestinal system, especially in organs that are highly sensitive to radiation and nearby other critical structures, including the heart and the lungs, kidneys, bladder, and bowels.

Liver Cancer

Liver cancers including hepatocellular carcinoma and cholangiocarcinoma were some of the earliest cancers to utilize proton radiotherapy.1,2,3 This is because the liver is a particularly well suited organ to benefit from the characteristics of proton therapy. Proton radiotherapy enables very high doses of radiation to be delivered to the cancer while avoiding radiation dose to the remainder of the liver. This type of treatment can be difficult to achieve with tradiational radiation. Protons reduce the risk of injury to the normal liver and other organs near the liver, including the intestines, heart, and lungs.4  Thousands of patients worldwide have been treated with proton radiotherapy for liver cancers.

Esophageal Cancer

For many esophageal cancers, combined therapy (e.g., chemoradiation and surgery or chemotherapy and radiation) provides the best treatment. Proton therapy is an advanced form of radiotherapy that can deliver targeted radiation to the treatment area and minimize harm to surrounding healthy tissue. Because the esophagus is located adjacent to critical organs like the lungs and the heart, proton radiotherapy is ideally suited to deliver curative radiation to the cancer while reducing the dose to the heart and lungs.

Among the advantages are reduced treatment related complications including reduced inflammation of the lungs (pneumonitis) and reduced damage to the heart.5,6 Reducing the impact of curative treatment on normal, healthy lungs and heart tissue may significantly improve the quality of life and long-term survival of esophageal cancer patients.  A randomized trial comparing proton radiotherapy and IMRT (X-ray therapy) for operable and inoperable esophageal cancer showed reduced heart and lung complications in patients receiving proton therapy compared to IMRT.7 

1 Kawashima M, Furuse J, Nishio T, et al. Phase II study of radiotherapy employing proton beam for hepatocellular carcinoma. J Clin Oncol. 2005;23(9):1839-1846.

2 Mizumoto M, Oshiro Y, Okumura T, et al. Proton beam therapy for hepatocellular carcinoma: A review of the University of Tsukuba experience. Int J Part Ther. 2016;2(4):570-578.

3 Nakayama H, Sugahara S, Tokita M, et al. Proton beam therapy for hepatocellular carcinoma. Cancer. 2009;115(23):5499-5506.

4 Sanford NN, Pursley J, Noe B, et al. Protons versus photons for unresectable hepatocellular carcinoma: Liver decompensation and overall survival. Int J Radia Oncol Bio Phys. 2019;105(1):64-72.

5 Prayongrat A, Xu C, Li H, Lin SH. Clinical outcomes of intensity modulated proton therapy and concurrent chemotherapy in esophageal carcinoma: a single institutional experience. Advances in Radiation Oncology. 2017;2(3):301-307.

6 Xi M, Xu C, Liao Z, Chang JY. Comparative outcomes after definitive chemoradiotherapy using proton beam therapy versus intensity modulated radiation therapy for esophageal cancer: A retrospective, single-institutional analysis. Int J Radia Oncol Bio Phys. 2017;99(3):667-676.

7 Lin SH, Hobbs BP, Verma V, et al. Randomized Phase IIB trial of proton beam therapy versus intensity-modulated radiation therapy for locally advanced esophageal cancer. J Clin Oncol. 2020;38(14):1569-1579.

The types of GI Cancers treated at the UF Health Proton Therapy Institute include:

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