title: Simultaneous integrated boost intensity-modulated radiotherapy in esophageal carcinoma: early results of a phase II study.
abstract: OBJECTIVE
  The safety and efficacy of using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for patients with esophageal squamous cell carcinoma were evaluated in a single-institution phase II setting.
  
  
  METHODS
  Between June 2007 and October 2009, 45 patients underwent concurrent chemoradiotherapy (n = 27) or radiotherapy alone (n = 18). Two planning target volumes (PTV) were defined for the SIB: PTVC and PTVG, with prescribed doses of 50.4 Gy to the PTVC (1.8 Gy/fraction) and 63 Gy to the PTVG (2.25 Gy/fraction), both given in 28 fractions.
  
  
  RESULTS
  At a median follow-up interval of 20.3 months, the 3-year overall survival (OS) and progression-free survival (PFS) rates were 42.2 and 40.7 %, respectively. The median overall survival time was 21 months; locoregional control rates were 83.3 % at 1 year and 67.5 % at 3 years. According to CTCAE (version 3.0) criteria, none of the patients developed grade 4-5 toxicity. The most common grade 2 and 3 radiation-related toxicity was radiation esophagitis, occurring in 64 % of all patients (but only 13 % as grade 3). No patient developed grade > 2 pulmonary complications.
  
  
  CONCLUSIONS
  SIB-IMRT is a feasible therapeutic approach for esophageal carcinoma patients and provides encouraging locoregional control with a low toxicity profile. Further investigations should focus on dose escalation and optimization of the combination with systemic therapies.
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Yu
authors.forename: Zheng-Fei
authors.initials: ZF
authors.lastname: Zhu
authors.forename: Xiao-Long
authors.initials: XL
authors.lastname: Fu
authors.forename: Kuai-Le
authors.initials: KL
authors.lastname: Zhao
authors.forename: Jing-Fang
authors.initials: JF
authors.lastname: Mao
authors.forename: Kai-Liang
authors.initials: KL
authors.lastname: Wu
authors.forename: Huan-Jun
authors.initials: HJ
authors.lastname: Yang
authors.forename: Min
authors.initials: M
authors.lastname: Fan
authors.forename: Sen
authors.initials: S
authors.lastname: Zhao
authors.forename: James
authors.initials: J
authors.lastname: Welsh
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D019583:Dose Fractionation, Radiation; D004938:Esophageal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy*; D004941:Esophagitis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome