A new approach to radiation therapy may offer patients with esophageal cancer and non-small cell lung cancer a better balance between effectiveness and quality of life.
Researchers at Fox Chase Cancer Center have found that pulsed low dose rate (PLDR) chemoradiation therapy can significantly cut treatment side effects while still delivering strong cancer control.
The results, from a phase I clinical trial, were presented at the American Society for Radiation Oncology (ASTRO) 2025 Annual Meeting.
Dr. Joshua Meyer, Vice Chair of Translational Research and Professor of Radiation Oncology at Fox Chase, led the trial.
“Traditionally, we’ve been limited in how much radiation we could safely give these patients,” Dr. Meyer explained.
“Severe side effects, especially painful swallowing, are common.
What makes this new technique exciting is that we’re not sacrificing cancer control—we’re delivering the same effective dose, but in a smarter way that protects healthy tissue.”
The trial enrolled 39 patients with locally advanced disease, including 35 with esophageal cancer and four with non-small cell lung cancer.
All patients received standard chemotherapy with carboplatin and paclitaxel, paired with PLDR radiation over a period of five-and-a-half to six weeks.
Unlike conventional radiation, which delivers a dose all at once, PLDR works by splitting the dose into multiple small pulses, separated by short breaks.
These breaks give healthy cells time to repair DNA damage caused by radiation. Cancer cells, however, are much less capable of repairing themselves and cannot take advantage of the pause, making the treatment just as effective against tumors.
The results were promising. Severe esophagitis—painful inflammation of the esophagus that can require feeding tubes or IV fluids—was cut from the typical 40 percent rate seen with standard chemoradiation to just 26 percent in the PLDR group.
Survival outcomes also held strong, with patients reaching a median overall survival of 45 months.
Among esophageal cancer patients who went on to surgery, nearly one in five had no cancer left in their tissue samples, and another 23 percent had only tiny traces of cancer remaining.
“We were very pleased to see we could cut severe esophagitis roughly in half, while keeping the therapy just as effective,” Dr. Meyer said.
PLDR was originally developed at Fox Chase by Dr. Chang-Ming Charlie Ma, Vice Chair of Radiation Oncology and Director of Radiation Physics, who created much of the methodology for delivering radiation in pulses.
While the technique has previously been used to retreat patients with recurring cancers, this trial marks the first time it has been tested as an initial treatment.
The findings represent an important step toward making PLDR a frontline option for cancer care, potentially giving patients both better outcomes and fewer burdens from side effects.
Source: Temple University.
