Executive summary

 In this guideline document, the dosimetric data and clinical evidence of PBT for esophageal cancer (EC) was summarized and evaluated. The clinical outcome data supports PBT for the management of EC in the settings of neoadjuvant and definitive as well as reirradiation. Patient selection criteria are recommended in this guideline document. Treatment planning, delivery techniques, motion management, quality assurance and adaptive planning are also detailed. The PTCOG thoracic and gastrointestinal subcommittees concluded in this guideline document that PBT should be strongly considered for tri-modality and nonoperative thoracic EC patients based on retrospective and randomized prospective data that demonstrates clinically meaningful reductions in toxicity compared to XRT. Long-term toxicity and efficacy outcomes of PBT versus XRT are being evaluated in the ongoing NRG-GI006 phase 3 randomized trial (NCT03801876).

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