Background: Conventional photon-based radiotherapy, such as with intensity-modulated radiation therapy and three-dimensional conformal radiation therapy, remains the standard treatment for oesophageal cancer where radiotherapy is required. However, they are associated with potential radiotoxicity to surrounding organs that confer significant morbidity and mortality. Proton beam therapy has emerged as a new technology with the potential to reduce organ at risk radiation through more precise tumour targeting. This updated systematic review and meta-analysis evaluates the efficacy and safety of proton beam therapy compared to conventional radiotherapy for oesophageal cancer. Methods: A comprehensive literature search was conducted across Medline, Embase and Cochrane Central databases. Articles which evaluated clinical outcomes and dosimetry data for proton beam therapy compared to conventional radiotherapy in patients with oesophageal cancer were included in this review. Results: Thirty-three studies, predominantly from the United States of America, were included. Pooled analysis demonstrates strong evidence to suggest proton beam therapy led to reduced grade 4 lymphopenia, reduced total pulmonary complications, improved odds in overall and progression free survival and reduced organ at risk radiation compared to conventional radiotherapy. These findings occur on the background of studies at low-moderate risk of bias but high clinical heterogeneity. Conclusion: There is preliminary evidence to suggest proton bream therapy reduces organ at risk radiation and radiotoxicity in oesophageal cancer. While these findings support the potential use of proton therapies, the limitations of the underlying evidence calls for further research to validate the long-term radiotoxicity and oncological outcomes before implementation of this therapy in policy and practice can occur.

Scar management and wound healing remains a significant challenge in plastic and reconstructive surgery. Recent advances in biologic injectables have introduced a regenerative paradigm. Among the most widely used options are exosome-based therapies and polynucleotide solutions such as Rejuran, both of which have shown encouraging results in improving scar texture, quality and pigmentation. Exosomes are nanosised extracellular vesicles that mediate intercellular communication and modulate key processes such as inflammation, angiogenesis, and collagen synthesis. Early studies suggest that exosome therapy enhances wound healing and scar remodeling by promoting cell proliferation and migration while reducing the inflammatory responses. Their efficacy appears particularly notable when combined with microneedling or laser therapy. Polynucleotides, such as Rejuran, are derived from salmon DNA and stimulate dermal regeneration by activating fibroblasts and enhancing extracellular matrix synthesis. Clinical studies from South Korea and Singapore have demonstrated significant improvements in both Patient and Observer Scar Assessment Scale (POSAS) scores and dermal thickness following treatment. Unlike exosomes, which act through paracrine signaling pathways, Rejuran primarily functions as a scaffold, supporting tissue repair, hydration and structural integrity. While direct comparative evidence remains limited, emerging data suggest that exosome-based therapies may offer faster epithelial recovery and reduced post-injection inflammation, whereas Rejuran benefits from established safety profiles and regulatory approval. While larger randomised controlled trials are warranted to compare both treatments and establish clinical protocols, both options represent promising adjuncts in the evolving field of regenerative scar management.