Is dose escalation achievable for esophageal carcinoma?

Abstract

Dose escalation for esophageal cancer becomes clinically feasible with the use of RA and HT. This promising result could be explored in a carefully controlled clinical study which considered normal tissue complications and tumor control as endpoints.

Intrafraction esophageal motion in patients with clinical T1N0 esophageal cancer

“…Vieillevigne and colleagues examined the feasibility of dose escalation using IMRT for thoracic esophageal cancer. 15 In an era of high-precision external beam radiotherapy, the data of intrafraction and interfraction motion must be mandatory for carcinoma of other sites as well as of the esophagus. In the report of Cvek et al, they estimated intrafraction and interfraction motion of liver tumors.…”

Initial experience of high-dose helical tomotherapy for medically inoperable esophageal cancer patients

“…After that, when three dimensional conformal radiotherapy (3D-CRT) became to be used, Chen et al reported that the 1-, 3-and 5-years OS rates for patients treated with radiotherapy alone were 69.9%, 34.3% and 26.5%, respectively, and no significant difference in survival was found between patients with or without chemotherapy [7]. In recent years, advanced radiotherapy techniques such as IMRT, VMAT, and HT have been used, and the cumulative dose in adjacent normal organs can be significantly reduced [2,3]. Ge et al reported IMRT using a linear accelerator in patients with locally advanced esophageal cancer [8].…”

“…However, the optimal dose and fractionation schedules of radiotherapy have not been clarified in the era when intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) are widespread. HT is a form of rotational IMRT in which treatment is delivered in a continuous helix and this unique feature allows the delivery of high-dose radiation to a complex and large volume, such as esophageal carcinoma, while sparing normal tissues [2,3]. Where there is no distant metastasis, local tumor control may alleviate the symptoms and even possibly prolong the survival of the patient.…”

Definitive chemoradiotherapy

“…Investigators from Japan and China consider total doses of 59.4 to 66 Gy in 30-33 fractions as standard radiotherapy (25,26). Modern radiation techniques like IMRT and VMAT using simultaneous integrated boost radiotherapy have been shown to considerably decrease the dose to critical organs like heart and lungs (27,28). Excellent results have been reported from a phase II trial (n=60) using these technologies to administer 66 Gy in 30 fractions in combination with 2 cycles of cisplatin and 5-FU (29).…”