Simultaneous integrated boost intensity-modulated radiotherapy in esophageal carcinoma

Abstract

SIB-IMRT is a feasible therapeutic approach for esophageal carcinoma patients and provides encouraging locoregional control with a low toxicity profile. Further investigations should focus on dose escalation and optimization of the combination with systemic therapies.

Radiobiological evaluation of simultaneously dose-escalated versus non-escalated intensity-modulated radiation therapy for patients with upper thoracic esophageal cancer

“…Apart from dosimetric investigations, an increase in the number of clinical trials has also demonstrated the feasibility and efficacy of the DE-IMRT technique for EC patients, with encouraging improvement in local control and well tolerated acute toxicities, although the escalated dose was slightly different. Both Yu et al and Chen et al initiated a phase II study to investigate the efficacy of radiation dose escalation using the DE-IMRT technique combined with chemotherapy, for the treatment of EC patients 11,13. The results showed a similar trend of improvement in local-regional control and overall survival, indicating that the method of theoretical evaluation could obtain results that were similar to those obtained in clinical practices.…”

“…Therefore, the question was raised whether it is feasible to escalate the dose to the tumor to improve local control, while maintaining clinically acceptable side effects to normal tissues. Increasing evidence has demonstrated that the SIB technique is more clinically beneficial for EC patients;11–13 however, the difference in the radiobiological response, particularly for esophageal toxicity between the DE-IMRT and NE-IMRT strategies for UTEC patients, remains unknown. To the best of our knowledge, this is the first study to compare tumor control and esophageal toxicity between two dosing strategies using radiobiological evaluation.…”

“…Radiotherapy technique was reported be significantly correlated with grade ≥2 AET and it might partly influence the esophageal toxicity prediction 23. We preferred the prediction obtained from the Kwint model, because CCRT with IMRT administration is the recommended strategy for the definitive treatment of EC patients in most publications,11–13,18 however, further clinical data are needed to validate the model.…”

“…Dose escalation using a simultaneous integrated boost (SIB) is a novel technique in which an accelerated higher dose, and a conventional lower dose can be delivered to the primary tumor and the subclinical disease simultaneously 10. Recently, an increasing number of studies have demonstrated its feasibility, efficacy, and safety for the treatment of EC patients with the combination of IMRT and dose escalation techniques 11–13. However, to the best of our knowledge, only several studies investigated the potential benefits of dose-escalated IMRT (DE-IMRT) to offer a dose escalation to the primary tumor, and improve the sparing of normal tissues compared with non-escalated IMRT (NE-IMRT) for EC patients 14–16.…”

“…However, to the best of our knowledge, only several studies investigated the potential benefits of dose-escalated IMRT (DE-IMRT) to offer a dose escalation to the primary tumor, and improve the sparing of normal tissues compared with non-escalated IMRT (NE-IMRT) for EC patients 14–16. Unfortunately, the studies failed to provide further information on esophageal toxicity, which is a common radiation-induced side effect in the treatment of EC patients 11,12,17,18…”