title: CRT combined with a sequential VMAT boost in the treatment of upper thoracic esophageal cancer.
abstract: The purpose of this study is to investigate the potential benefits of conformal radiotherapy (CRT) combined with a sequential volumetric-modulated arc therapy (VMAT) boost in the treatment of upper thoracic esophageal cancer. Ten patients with upper thoracic esophageal cancer previously treated with CRT plus a sequential VMAT boost plan were replanned with CRT plus an off-cord CRT boost plan and a full course of VMAT plan. Dosimetric parameters were compared. Results indicated that CRT plus off-cord CRT boost was inferior in planning target volume (PTV) coverage, as indicated by the volume covered by 93% (p = 0.05) and 95% (p = 0.02) of the prescription dose. The full course VMAT plan was superior in conformal index (CI) and conformation number (CN), and produced the highest protection for the spinal cord. CRT plus a VMAT boost demonstrated significant advantages in decreasing the volume of the lung irradiated by a dose of 10 Gy (V10, p = 0.007), 13 Gy (V13, p = 0.003), and 20 Gy (V20, p = 0.001). The full course VMAT plan demonstrated the lowest volume of lung receiving a dose of 30 Gy. CRT plus a VMAT boost for upper thoracic esophageal cancer can improve the target coverage and reduce the volume of lung irradiated by an intermediate dose. This combination may be a promising treatment technique for patients with upper thoracic esophageal cancer.
authors.affiliation: The 1st Affiliated Hospital of Wenzhou Medical College. jinxc1979@hotmail.com.
authors.forename: Xiance
authors.initials: X
authors.lastname: Jin
authors.forename: Jinling
authors.initials: J
authors.lastname: Yi
authors.forename: Yongqiang
authors.initials: Y
authors.lastname: Zhou
authors.forename: Huawei
authors.initials: H
authors.lastname: Yan
authors.forename: Ce
authors.initials: C
authors.lastname: Han
authors.forename: Congying
authors.initials: C
authors.lastname: Xie
mesh_terms: D004938:Esophageal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D013899:Thoracic Neoplasms / Q000473:pathology / Q000532:radiotherapy*
references.citation: Radiother Oncol. 2009 Nov;93(2):226-33
references.pmid: 19765846
references.citation: Radiother Oncol. 2008 Dec;89(3):287-91
references.pmid: 18789828
references.citation: Br J Radiol. 2012 Jan;85(1009):44-52
references.pmid: 21427179
references.citation: Int J Radiat Oncol Biol Phys. 1998 Aug 1;42(1):1-9
references.pmid: 9747813
references.citation: Int J Radiat Oncol Biol Phys. 2008 Aug 1;71(5):1408-18
references.pmid: 18262730
references.citation: Int J Radiat Oncol Biol Phys. 2006 Mar 1;64(3):692-9
references.pmid: 16242257
references.citation: Med Dosim. 2012 Spring;37(1):108-13
references.pmid: 21940159
references.citation: Int J Radiat Oncol Biol Phys. 2006 May 1;65(1):255-65
references.pmid: 16618580
references.citation: Int J Radiat Oncol Biol Phys. 2003 Apr 1;55(5):1409-19
references.pmid: 12654454
references.citation: Clin Oncol (R Coll Radiol). 2009 Jun;21(5):401-7
references.pmid: 19268554
references.citation: Radiother Oncol. 2010 May;95(2):142-8
references.pmid: 20188427
references.citation: Int J Radiat Oncol Biol Phys. 1993 Jan;25(1):135-45
references.pmid: 8416870
references.citation: Int J Radiat Oncol Biol Phys. 1999 Sep 1;45(2):323-9
references.pmid: 10487552
references.citation: Int J Radiat Oncol Biol Phys. 1995 Jul 15;32(4):1227-37
references.pmid: 7607946
references.citation: Int J Radiat Oncol Biol Phys. 2003 Dec 1;57(5):1317-22
references.pmid: 14630268
references.citation: Med Dosim. 2011 Winter;36(4):404-9
references.pmid: 21377864
references.citation: Int J Radiat Oncol Biol Phys. 1997 Feb 1;37(3):731-6
references.pmid: 9112473
references.citation: Int J Radiat Oncol Biol Phys. 2004 Jul 15;59(4):1257-9; author reply 1259-61
references.pmid: 15234063