Published in the Red Journal, this study from the Groningen group is a retrospective analysis of 313 patients with esophageal cancer treated with neoadjuvant chemoradiation therapy (nCRT) either with proton (n=65) or photon (n=248) followed by surgical resection. Eighty-seven (28%) patients had pneumonia within 6 months after the end of nCRT. 85 patients had grade 2 or 3 pneumonia (symptomatic). Grade 4 pneumonia (life-threatening) was only seen in 2 patients, both treated with PhRT. The incidence was lower after PRT compared with PhRT (12% vs 32%, P < .01). Pneumonia occurred between the end of RT and the resection in 3 patients (3%), within 30 days after surgery in 78 patients (90%), and pneumonia developed after the 30-day post-operative period in the remaining 6 cases (7%). In the PRT group, 8 out of 65 patients (12%) were diagnosed with pneumonia after a median time of 4 days after surgical resection compared with 79 out of 248 (32%) in the PhRT group(P < .01), 6 days (median) after resection. The reduction of pneumonia was associated with the lower mean dose and a reduction of the volume irradiated to low doses in the lungs and/or heart.