A pioneering proton radiotherapy approach is employed in Switzerland to treat oesophageal cancer, with a 67-year-old patient being the first beneficiary. This innovative treatment aims to reduce lung complications and is part of a European clinical trial involving the Paul Scherrer Institute and University Hospital Zurich. Protons’ precision and reduced impact on healthy tissue offer potential advantages. The PROTECT trial, involving 19 European partners, seeks to validate these benefits and potentially reshape oesophageal cancer treatment, enhancing outcomes and expanding insurance coverage.
In a landmark medical development, a 67-year-old patient diagnosed with oesophageal cancer has undergone a revolutionary treatment at the Paul Scherrer Institute (PSI) using proton radiotherapy, a novel approach employing positively charged particles. This marks the inaugural utilization of this innovative technique in Switzerland for the treatment of oesophageal tumors. Conducted over five weeks, this therapeutic regimen is part of a collaborative European clinical trial spearheaded by both PSI and the University Hospital Zurich (USZ). Researchers in the medical field are exploring the viability of proton therapy as a potential treatment for this specific type of cancer, with the prospect of reducing lung complications often associated with conventional radiotherapy.
Damien Weber, the distinguished senior clinician, and Head of the Center for Proton Therapy (CPT) at PSI, confirms, “Today marks a historic milestone as we administer proton radiotherapy to treat oesophageal cancer within the framework of a comprehensive European Phase III clinical trial. The patient, aged 67, harbors a Siewert type II tumor located at the esophagogastric junction, which will undergo resection following our groundbreaking treatment.” Since 1996, PSI has been at the forefront of effectively treating patients afflicted by head and neck, and spinal tumors; however, this innovative approach has not been employed in Switzerland for oesophageal cancer treatment until now. Matthias Guckenberger, the esteemed Medical Director and Head of the Department of Radiation Oncology at the University Hospital Zurich (USZ) expresses his enthusiasm, stating, “The ability to extend this form of treatment to patients in Switzerland as part of a clinical trial is truly gratifying.”
Leveraging their longstanding collaboration in cancer care, USZ and PSI are collaboratively embarking on a research venture to ascertain whether proton therapy offers distinctive advantages in radiotherapy for oesophageal cancer. This research initiative is an integral facet of the pan-European PROTECT trial (PROton versus photon Therapy for Esophageal Cancer: a Trimodality Strategy), aimed at juxtaposing the side effects of traditional radiotherapy with proton therapy for treating oesophageal cancer.
Catering to the treatment complexities of this uncommon cancer type, approximately 600 individuals are diagnosed annually in Switzerland with oesophageal cancer, predominantly affecting men. Despite its rarity, it is the eighth most prevalent cancer type worldwide. Treatment typically involves a combination of chemotherapy and radiation, followed by surgical intervention to excise the residual tumor and associated lymph nodes. Given that tumor removal often necessitates removing a portion of the oesophagus, the remaining healthy segments are subsequently linked to the stomach.
Regrettably, conventional radiotherapy for oesophageal cancer can lead to various degrees of complications in adjacent organs, particularly the lungs. This delicate organ resides near the oesophagus within the thoracic cavity and frequently endures adverse impacts from radiation targeted at the tumor site. Consequently, many patients encounter complications such as pneumonia and other issues, potentially impeding critical surgery or post-operative recovery.
Proton therapy emerges as a prospective solution. Damien Weber expresses optimism, stating, “Our aspiration is for proton radiotherapy to significantly mitigate lung complications. Our goal is to validate this prediction and enhance the well-being of all cancer patients.” While both protons and photons (employed in traditional radiotherapy) are capable of damaging the DNA of tumor cells, effectively neutralizing them, modern-day precision in X-ray targeting can inadvertently affect surrounding healthy tissue, leading to collateral damage. In contrast, protons are electrically charged particles, and their depth of tissue penetration is meticulously pre-calibrated. As protons traverse the tissue, they retain their energy until they reach the tumor, where they exert their primary effect. This methodology significantly diminishes the risk of harming healthy tissue surrounding the tumor, fostering hope for reduced lung complications following a course of radiotherapy.
An extensive collaborative endeavor encompassing nineteen research entities across Europe, including universities, hospitals, and research centers, is unified under the PROTECT trial banner. Dominic Leiser, distinguished radiation oncologist and Head of Clinical Studies at PSI notes, “Our close collaboration enhances our recruitment potential, allowing us to include several hundred participants and thereby augment the weight of our study results.” Spearheaded by Aarhus University in Denmark, PSI played a pivotal role as one of the instigators of this pan-European project.
The study aims to treat nearly 400 patients afflicted with non-metastatic oesophageal cancer, with around 20 participants based in Switzerland. The treatment protocol entails a combination of radiotherapy and chemotherapy, followed by surgical intervention to remove the tumor six to twelve weeks later. Approximately half of the participants will undergo conventional photon X-ray treatment at USZ, while the rest will be administered proton therapy at PSI. The PROTECT trial is structured as a randomized study, enabling a direct comparison between the outcomes of both treatment modalities. At USZ, all participants will undergo both conventional radiotherapy and chemotherapy, culminating in surgical tumor residue removal.
Panagiotis Balermpas, the esteemed principal investigator and Senior Physician at the Department for Radiation Oncology at USZ elucidates, “Our comprehensive approach incorporates all three modes of cancer therapy to optimize outcomes for this particular cancer type. Whether patients receive photons or protons, they will receive the utmost care throughout the study.”
The PROTECT trial actively welcomes new patients, evaluating their eligibility for study participation. The trial extends its reach to patients with tumors at the gastro-oesophageal junction, where the oesophagus converges with the stomach.
If the potential advantages of proton radiotherapy for oesophageal cancer are substantiated, Damien Weber asserts, “Successful validation could lead to the inclusion of this tumor type in the Ministry of Health’s list of indications. This pivotal step would entail medical insurance coverage for proton therapy as a treatment option for oesophageal cancer in the future.” Matthias Guckenberger concurs, affirming, “This represents a significant advancement in the treatment landscape for oesophageal cancer and an enhancement of the existing therapeutic repertoire.”
