Dosimetric comparison between three-dimensional conformal radiation therapy versus intensity-modulated radiation therapy in non-metastatic esophageal carcinoma patients receiving definitive radiation with concurrent chemotherapy
a prospective single institutional study
Abstract
Background: Esophageal cancer, a highly aggressive and often fatal gastrointestinal disease, frequently reaches advanced unresectable stages. The standard treatment involves definitive chemoradiation due to concerns about regional failure. To address this, intensified radiation dosages and advanced techniques like Intensity-Modulated Radiation Therapy (IMRT) and Three-Dimensional Conformal Radiation Therapy (3D-CRT) are being explored. This study aimed to compare dosimetric factors in patients with esophageal carcinoma undergoing IMRT versus 3D-CRT treatments.Methods: Twenty patients were alternately assigned to receive either treatment. Each patient's alternate virtual plan resulted in a total of forty plans. Dosimetric evaluations included coverage of the Planning Target Volume (PTV) and dose-volumes of lungs, heart, and spinal cord. Treatment consisted of 50.4 Gy radiation with concurrent weekly paclitaxel and carboplatin chemotherapy. Statistical analysis was conducted using the two-tailed Paired t-Test.Results: Dosimetric evaluations revealed no significant distinctions in PTV parameters such as maximum dose, minimum dose, mean dose, D2%, D50%, and V95% between IMRT and 3D-CRT plans. However, IMRT exhibited improvements in D98% and Homogeneity Index. While Conformity Index did not differ significantly, IMRT displayed reduced lung irradiation in various aspects such as Dmean, V20, and V30, while 3D-CRT showed lower irradiation in V5 and V10. IMRT effectively spared the heart with lowered heart irradiation in V30. Spinal cord Dmax remained consistent across both techniques.Conclusions: IMRT demonstrated better dose homogeneity and superior lung and heart sparing capabilities compared to 3D-CRT in treating esophageal carcinoma. While both techniques had similar dose conformity, IMRT's potential to reduce long-term radiation-induced lung and heart complications through improved sparing of these organs is noteworthy.
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2. Corley DA, Buffler PA. Oesophageal and gastric cardia adenocarcinomas: analysis of regional variation using the Cancer Incidence in Five Continents database. Int J Epidemiol 2001; 30:1415-1425.
3. Halperin EC, Wazer DE, Perez CA, Brady LW. Esophageal cancer. In: Perez CA, Brady LW, Halperin EC, eds. Perez and Brady’s principles and practice of radiation oncology. 7th ed. Philadelphia: Wolters Kluwer; 2018. p. 1457-1492.
4. World Health Organization. International Agency for Research on Cancer. GLOBOCAN 2018: oesophagus cancer fact sheet. 2018. Available from: http://gco.iarc.fr/today/data/factsheets/cancers/6Oesophagus-fact-sheet.pdf.
5. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68:394-424. doi:10.3322/caac.21492
6. Brown LM, Devesa SS, Chow WH. Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst 2008; 100:1184-7. doi:10.1093/jnci/djm274
7. Globocan 2008. Available from: http://globocan.iarc.fr/factsheet.asp (accessed 9th December 2012).
8. Rasool S, Ganai A, Syed Sameer A, Masood A. Esophageal cancer: associated factors with special reference to the Kashmir Valley. Tumori 2012 Mar-Apr; 98(2):191-203. doi:10.1177/039000671209800202
9. Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 2002; 20:1167-1174. doi:10.1200/JCO.2002.01.118
10. Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366:2074-84. doi:10.1056/NEJMoa1200699
11. Wu Y, Zhang L, Chen W, et al. Intensity-modulated radiation therapy (IMRT) for the treatment of esophageal cancer: A systematic review and meta-analysis. BMC Cancer 2018; 18(1):1080. doi:10.1186/s12885-018-4156-7
12. Kim SH, Lee JW, Park JY, et al. A comparison of IMRT and 3D-CRT for the treatment of esophageal cancer: A systematic review and meta-analysis. J Thorac Oncol 2016; 11(11):1955-1964. doi: 10.1016/j.jtho.2016.07.016
13. Zhang L, Wu Y, Chen W, et al. The dosimetric impact of intensity-modulated radiation therapy on the heart and lungs in patients with esophageal cancer. Radiat Oncol 2018; 13(1):118. doi:10.1186/s13
| Files | ||
| Issue | Vol 15 No 1 (2023) | |
| Section | Original Articles | |
| Keywords | ||
| Esophageal carcinoma Dosimetry 3D-CRT & IMRT | ||
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How to Cite
1.
Ali SH, Chakrabarti A. Dosimetric comparison between three-dimensional conformal radiation therapy versus intensity-modulated radiation therapy in non-metastatic esophageal carcinoma patients receiving definitive radiation with concurrent chemotherapy. Basic Clin Cancer Res. 2024;15(1):36-41.
