title: Image-guided Radiotherapy Of Esophageal Cancer By Helical Tomotherapy: Acute Toxicity And Preliminary Clinical Outcome.
abstract: BACKGROUND
  Helical tomotherapy is a novel intensity-modulated radiotherapy modality with a helical 360° radiation delivery system and CT imaging ability. The purpose of this report is to review our initial experiences and to assess the toxicity and efficacy of helical tomotherapy for esophageal cancer.
  
  
  METHODS
  Twenty patients with locally advanced esophageal cancer (T3-4 and/or N+ and/or M1a/b) were treated with helical tomotherapy. Radiotherapy included simultaneous 50 Gy to gross tumorous areas and 45 Gy to areas of suspected subclinical disease. All received combination chemotherapy. Ten patients underwent surgical resection after completion of chemoradiation. Ten patients were ineligible for surgery.
  
  
  RESULTS
  The treatment was well-tolerated. There were no treatment-related deaths or Grade 4 toxicity. Grade 3 toxicities were noted in 9 of 20 patients (45%). Down-staging was noted in 7 of 10 patients (70%) who underwent surgery. The median follow-up time was 24.5 months. Eight patients, including 3 with surgery and 5 without surgery, have died. The 1-year overall survival rates for the entire group, patients with and without surgical resection are 80.0%, 100.0% and 60.0% respectively (log-rank p = 0.244, surgery versus no surgery).
  
  
  CONCLUSIONS
  The regimen of combined chemoradiation by helical tomotherapy for locally advanced esophageal cancer is well-tolerated. The toxicity profile compares favorably with that of protocols based on conventional approach and the preliminary indications of efficacy are encouraging.
authors.affiliation: Divisions of Radiation Oncology (Drs Chen, Liu, Pezner, and Wong, and Martin Tang), Thoracic Surgery (Dr Kernstine), Medical Oncology (Drs Shibata and Lim), Biostatistics (Dr Smith), City of Hope Medical Center, Duarte, CA, USA.
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Chen
authors.forename: Kemp
authors.initials: K
authors.lastname: H Kernstine
authors.forename: Stephen
authors.initials: S
authors.lastname: Shibata
authors.forename: Dean
authors.initials: D
authors.lastname: Lim
authors.forename: David
authors.initials: D
authors.lastname: D Smith
authors.forename: Martin
authors.initials: M
authors.lastname: Tang
authors.forename: An
authors.initials: A
authors.lastname: Liu
authors.forename: Richard
authors.initials: R
authors.lastname: D Pezner
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Y C Wong