Dosimetric comparison of IMRT vs. 3D conformal radiotherapy in the treatment of cancer of the cervical esophagus

Fenkell, Louis; Kaminsky, I.; Breen, Stephen; Huang, Szu-Han; Prooijen, Monique van; Ringash, Jolie

doi:10.1016/j.radonc.2008.08.008

Cited by 134 publications

(98 citation statements)

References 19 publications

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“…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).…”

Section: Discussionmentioning

confidence: 99%

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

Zhu

Zhou²,

Chen³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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For patients with neck and upper thoracic esophageal carcinoma, it is difficult to control lymph node metastases with conventional dose therapy. In this study, we assessed the feasibility of simplified intensity-modulated radiotherapy (sIMRT) and concurrent chemotherapy for 44 patients and boosted high-dose to metastatic lymph nodes.Three radiation treatment volumes were defined: PGTVnd, with which 68.1Gy was delivered in high dose group (hsIMRT group), and 60Gy in the conventional dose group (csIMRT group); PTV1, featuring 63.9Gy in the hsIMRT group and 60Gy in the csIMRT group; PTV2, with 54Gy given to both groups. The sIMRT plan included 5 equi-angular coplanar beams. All patients received the cisplatin and 5-FU regimen concurrently with radiotherapy. The treatment was completed within six weeks and one case with grade three acute bronchitis was observed in hsIMRT group. For esophageal lesions, 80% complete response (CR) and 20% partial response (PR) rates were found in the hsIMRT group, and 79.2% CR, with 20.8% PR, in the csIMRT group; for lymph node lesions, 75% CR and 25% PR rates were observed in the hsIMRT group, with 45.8% and 37.5% respectively in the csIMRT group (P <0.05). The differences in 1-, 2-and 3-year relapse-free survival rates were all statistically significant (P <0.05). The major toxicity observed in both groups was Grade I~II leucopenia. sIMRT can generate a desirable dose distribution in treatment of neck and upper thoracic esophageal carcinoma with a better shortterm efficacy. Boosted high dosing to metastatic lymph nodes can increase the relapse-free survival rate.

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Section: Discussionmentioning

confidence: 99%

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

Zhu

Zhou²,

Chen³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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“…Conventional techniques may barely achieve a good conformity to the PTV, and often OAR such as the parotid glands receive an ablative dose of radiation leading to xerostomia. IMRT has been shown to achieve sparing of the parotid glands and reduce radiation-induced xerostomia in head and neck cancer [28][29][30][31]. In addition, conformity to the PTV is also improved with IMRT when compared with 3D conformal radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Clinical challenges in the implementation of a tomotherapy service for head and neck cancer patients in a regional UK radiotherapy centre

Chatterjee

Mott²,

Smyth³

et al. 2011

BJR

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Objective: Intensity-modulated radiotherapy (IMRT) is increasingly being used to treat head and neck cancer cases. Methods: We discuss the clinical challenges associated with the setting up of an image guided intensity modulated radiotherapy service for a subset of head and neck cancer patients, using a recently commissioned helical tomotherapy (HT) Hi Art (Tomotherapy Inc, WI) machine in this article. We also discuss the clinical aspects of the tomotherapy planning process, treatment and image guidance experiences for the first 10 head and neck cancer cases. The concepts of geographical miss along with tomotherapy-specific effects, including that of field width and megavoltage CT (MVCT) imaging strategy, have been highlighted using the first 10 head and neck cases treated. Results: There is a need for effective streamlining of all aspects of the service to ensure compliance with cancer waiting time targets. We discuss how patient toxicity audits are crucial to guide refinement of the newly set-up planning dose constraints. The advantages of intensity-modulated radiotherapy (IMRT) in head and neck cancer, in terms of target conformation, organ at risk sparing and associated improvement in quality of life, and the potential for dose escalation, have been well documented [1][2][3]. The development and commercial release of the helical tomotherapy (HT) Hi Art (Tomotherapy, Madison WI) system by Mackie et al [4] has introduced advanced helical IMRT delivery techniques and combined these with integrated onboard image guidance capabilities [5]. Recent adoption of this technology within the NHS by two centres (Cambridge and Newcastle), alongside existing provision within a private sector treatment centre (BUPA Cromwell Hospital, London), enables delivery of highly conformal image-guided IMRT in the UK.The physical characteristics of the HT system are described in detail elsewhere [4,5]; however, in basic terms, the system is a short waveguide 6 MV linac mounted on a spiral CT gantry system. Beam collimation is by a pneumatically controlled binary multileaf collimator (MLC), with each leaf projecting to 6.25 mm at isocentre, for three selectable field widths [6]. Owing to its continuous rotational delivery technique and rapid beam modulation throughout its full arc of travel, the HT system gives greater flexibility than conventional linear accelerator (linac)-based IMRT that provides intensity modulation at multiple fixed gantry angles. Planning comparisons between tomotherapy and rotational techniques using conventional linacs, volumetric arc therapy (VMAT) or intensity-modulated arc therapy (IMAT), have also been published [7,8]; however, there is ongoing debate as to the relative merits of each technique [9][10][11][12].The complexity of head and neck radiotherapy is due to the proximity of multiple organs at risk (OAR), including critical structures such as the brain stem and spinal cord and important functional organs such as the parotid glands, optic nerve, optic chiasm, larynx and mandible. The dose prescription ...

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“…In the case of existence of hot spot such as >110 % of the prescribed radiation dose, field-in-field technique is considered to improve the conformity of the dose distribution. More recently, intensity-modulated [17]. A potential disadvantage of IMRT is the possibility of delivering low doses of radiation therapy to normal-tissue areas.…”

Section: Field Designmentioning

confidence: 99%

Radiation Therapy

Ito¹

2014

Esophageal Squamous Cell Carcinoma

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Radiotherapy is indicated for the treatment of esophageal cancer both with curative intent and with palliative intent. Concurrent chemoradiotherapy is the standard treatment for patients in good condition who can receive chemotherapy, based on the result of randomized trial that compared chemoradiotherapy with radiotherapy alone. For locally advanced unresectable esophageal cancer, definitive chemoradiotherapy is the standard therapy with potentially curative intent. And for resectable esophageal cancer, definitive chemoradiotherapy is a treatment option in an attempt to preserve the esophagus from favorable results of clinical trials. These results are supported by salvage treatment in cases of residual or recurrent disease after chemoradiotherapy. However high mortality rate of salvage surgery and high incidence of late toxicities after chemoradiotherapy with higher radiation dose are important problems to be solved. Neoadjuvant chemoradiotherapy is standard treatment for locally advanced esophageal cancer in Western countries; however it is investigational in Japan. Combination chemotherapy of new agents and new radiotherapy technique such as intensity-modulated radiation therapy, protonbeam therapy, and heavy-particle radiotherapy have been evaluated in clinical trials to improve the treatment results including efficacy and toxicity.

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Dosimetric comparison of IMRT vs. 3D conformal radiotherapy in the treatment of cancer of the cervical esophagus

Cited by 134 publications

References 19 publications

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

Clinical challenges in the implementation of a tomotherapy service for head and neck cancer patients in a regional UK radiotherapy centre

Radiation Therapy

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