This meta-analysis reports proton therapy for locally-advanced esophageal cancer results in less toxicity, specifically grade 2+ pneumonitis and pericardial effusion and gade 4+ lymphopenia, and even—eyebrow-raisingly—longer survival than photon therapy. It’s important to note here this is not a meta-analysis of prospective comparisons between the two modalities. In fact, 28 of 45 included studies weren’t a comparison of modalities at all, and photon therapy included anything from 3D to IMRT to VMAT techniques. Another interesting strategy was: “If multiple proton techniques were available simultaneously in 1 study, the technique with the greatest comprehensive dose benefit to organs at risk was preferred.” Rather than all the post-hoc gymnastics, we humbly suggest conclusions be reserved for prospective head to head comparisons such as this one that revealed no difference in quality or life or survival outcomes. | Zhou, JAMA Netw Open 2023
