Esophageal Cancer Dose Escalation Using a Simultaneous Integrated Boost Technique

Overview

Journal Int J Radiat Oncol Biol Phys

Specialties Oncology
Radiology

Date 2010 Dec 3

PMID 21123005

Citations 49

Authors

James Welsh

Matthew B Palmer

Jaffer A Ajani

Zhongxing Liao

Steven G Swisher

Wayne L Hofstetter

Pamela K Allen

Steven H Settle

Daniel Gomez

Anna Likhacheva

James D Cox

Ritsuko Komaki

Affiliations

Soon will be listed here.

Abstract

Purpose: We previously showed that 75% of radiation therapy (RT) failures in patients with unresectable esophageal cancer are in the gross tumor volume (GTV). We performed a planning study to evaluate if a simultaneous integrated boost (SIB) technique could selectively deliver a boost dose of radiation to the GTV in patients with esophageal cancer.

Methods And Materials: Treatment plans were generated using four different approaches (two-dimensional conformal radiotherapy [2D-CRT] to 50.4 Gy, 2D-CRT to 64.8 Gy, intensity-modulated RT [IMRT] to 50.4 Gy, and SIB-IMRT to 64.8 Gy) and optimized for 10 patients with distal esophageal cancer. All plans were constructed to deliver the target dose in 28 fractions using heterogeneity corrections. Isodose distributions were evaluated for target coverage and normal tissue exposure.

Results: The 50.4 Gy IMRT plan was associated with significant reductions in mean cardiac, pulmonary, and hepatic doses relative to the 50.4 Gy 2D-CRT plan. The 64.8 Gy SIB-IMRT plan produced a 28% increase in GTV dose and comparable normal tissue doses as the 50.4 Gy IMRT plan; compared with the 50.4 Gy 2D-CRT plan, the 64.8 Gy SIB-IMRT produced significant dose reductions to all critical structures (heart, lung, liver, and spinal cord).

Conclusions: The use of SIB-IMRT allowed us to selectively increase the dose to the GTV, the area at highest risk of failure, while simultaneously reducing the dose to the normal heart, lung, and liver. Clinical implications warrant systematic evaluation.

Citing Articles

TMT-Based Quantitative Proteomic Profiling of Human Esophageal Cancer Cells Reveals the Potential Mechanism and Potential Therapeutic Targets Associated With Radioresistance.

Gao A, He C, Chen H, Liu Q, Chen Y, Sun J Proteomics Clin Appl. 2024; 19(1):e202400010.

PMID: 39375892 PMC: 11726268. DOI: 10.1002/prca.202400010.

Validation of esophageal cancer treatment methods from 3D-CRT, IMRT, and Rapid Arc plans using custom Python software to compare radiobiological plans to normal tissue integral dosage.

Dashnamoorthy S, Jeyasingh E, Rajamanickam K Rep Pract Oncol Radiother. 2023; 28(1):54-65.

PMID: 37122909 PMC: 10132189. DOI: 10.5603/RPOR.a2023.0002.

Combined modality therapy for patients with esophageal squamous cell carcinoma: Radiation dose and survival analyses.

Shueng P, Huang C, Liu Y, Wu Y, Huang P, Yen S Thorac Cancer. 2022; 14(2):143-148.

PMID: 36351568 PMC: 9834687. DOI: 10.1111/1759-7714.14724.

A Prospective Phase II Study of Simultaneous Modulated Accelerated Radiotherapy Concurrently With CDDP/S1 for Esophageal Squamous Cell Carcinoma in the Elderly.

Guo S, Liu F, Liu H, Wu Y, Zhang X, Ye W Front Oncol. 2021; 11:760631.

PMID: 34900709 PMC: 8654786. DOI: 10.3389/fonc.2021.760631.

Late Toxicities, Failure Patterns, Local Tumor Control, and Survival of Esophageal Squamous Cell Carcinoma Patients After Chemoradiotherapy With a Simultaneous Integrated Boost: A 5-Year Phase II Study.

Chen C, Chen J, Luo T, Wang S, Guo H, Zeng C Front Oncol. 2021; 11:738936.

PMID: 34868933 PMC: 8639085. DOI: 10.3389/fonc.2021.738936.

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