Comparison of conformal and intensity-modulated techniques for simultaneous integrated boost radiotherapy of upper esophageal carcinoma

Abstract

AIM:To compare intensity-modulated radiotherapy (IMRT) with conformal radiotherapy (CRT) by investigating the dose profiles of primary tumors, electively treated regions, and the doses to organs at risk. METHODS:CRT and IMRT plans were designed for five patients with upper esophageal carcinoma. For each patient, target volumes for primary lesions (67.2 Gy) and electively treated regions (50.4 Gy) were predefined. An experienced planner manually designed one CRT plan. Four IMRT plans were generated with the same dose-volume constraints, but with different beam arrangements. Indices including dose distributions, dose volume histograms (DVHs) and conformity index were compared. RESULTS:The plans with three intensity-modulated beams were discarded because the doses to spinal cord were lager than the tolerable dose 45Gy, and the dose on areas near the skin was up to 50Gy. When the number of intensity beams increased to five, IMRT plans were better than CRT plans in terms of the dose conformity and homogeneity of targets and the dose to OARs. The dose distributions changed little when the beam number increased from five to seven and nine. CONCLUSION:IMRT is superior to CRT for the treatment of upper esophageal carcinoma with simultaneous integrated boost (SIB). Five equispaced coplanar intensity-modulated beams can produce desirable dose distributions. The primary tumor can get higher equivalent dose by SIB technique. The SIB-IMRT technique shortens the total treatment time, and is an easier, more efficient, and perhaps a less errorprone way in delivering IMRT.Fu WH, Wang LH, Zhou ZM, Dai JR, Hu YM, Zhao LJ. Comparison of conformal and intensity-modulated techniques for simultaneous integrated boost radiotherapy of upper esophageal carcinoma.

Efficacy Analysis of Simplified Intensity-modulated Radiotherapy with High or Conventional Dose and Concurrent Chemotherapy for Patients with Neck and Upper Thoracic Esophageal Carcinoma

“…For patients with neck or upper thoracic esophageal carcinoma, radiotherapy is a major treatment method now. Esophageal carcinoma is often accompanied with supraclavicular or superior mediastinal lymph node metastasis, and correlated with poor prognosis (Kawahara et al, 1998;Kurokawa et al, 2003;Xiao et al 2003;Xiao et al, 2005;Tachimori et al, 2011) Research showed that IMRT technique can not only elevate target dose, but possesse advantages of higher target conformity, higher dose uniformity and better protection of sensitive organs compared with conventional conformal radiotherapy (Nutting et al, 2001;Fu et al, 2004;Wu et al, 2004;Chandra et al, 2005;Wang et al, 2006;Fenkell et al, 2008). It was reported 5~7 intensity-modulated beams were more effective in target dose uniformity, target conformity and radiation dose to organs at risk when comparing the effect of IMRT with that of 3D-CRT on 5 cases of upper esophageal carcinoma using simultaneous integrate boost (Fu et al, 2004).…”

Esophageal and Esophagogastric Junction Cancers

“…Experience with intraoperative radiation as an alternative to external beam radiation is limited. [121][122][123][124][125] Intensitymodulated radiation therapy (IMRT) is currently being investigated. Retrospective planning studies comparing three-dimensional (3D) conformal versus IMRT treatment plans for esophagus cancer have generally shown superior dose conformity and homogeneity with IMRT and reduction of radiation dose to the lungs and heart.…”

High FDG uptake areas on pre-radiotherapy PET/CT identify preferential sites of local relapse after chemoradiotherapy for locally advanced oesophageal cancer

“…RT dose escalation is a domain of active clinical research in oesophageal cancer, as illustrated by investigations with intensity-modulated RT (IMRT) [8][9][10][11][12][13], IMRT with protons [ 14] and the ongoing French trial CONCORDE (ClinicalTrials.gov Identifier: NCT01348217). A study in ten patients [8] showed that 66.4 Gy could be delivered with simultaneous integrated boost (SIB) IMRT, while reducing the dose to the normal heart, lung and liver, when compared to 50.4 Gy with more conventional 3D CRT plans.…”