Radiotherapy has become the standard of care in the curative treatment of locally advanced oesophageal cancer. Advanced radiotherapy techniques, such as intensity-modulated radiotherapy, can reduce doses to normal tissues resulting in lower toxicities and an improved outcome. The unique physical features of proton beam therapy has tremendous potential to further spare organs at risk. Besides the clear dosimetric advantages of proton beam therapy in oesophageal cancer, there is evidence that supports a clinical benefit. However, results from prospective randomised trials are awaited. To maximise the cost-effectiveness of this new technology, patient selection for proton beam therapy using validated multifactorial normal tissue complication probability models is suggested. However, this requires international collaboration to prospectively collect data of patients treated with proton beam therapy.

(BELG J MED ONCOL 2019;13(1):11–15)