title: Neoadjuvant Chemoradiotherapy with Volumetric-modulated Arc Therapy for Medium-distal Oesophageal and Gastro-oesophageal Junction Carcinoma.
abstract: OBJECTIVE
  to appraise the role of volumetric-modulated arc therapy (VMAT) in the neoadjuvant chemoradiotherapy management of advanced medium and distal oesophageal cancer in terms of toxicity and response to treatment.
  
  
  METHODS
  Thirty patients were treated according to the neoadjuvant chemoradiation followed by surgery versus surgery-alone trial scheme with VMAT radiation therapy. Patients presented mainly T3-T4 stage (80%) and N1-2 (96.6%) disease. The chemotherapy scheme consisted of 3-5 cycles, while a radiotherapy course of 41.4 Gy in 23 fractions was administered to all patients.
  
  
  RESULTS
  The median age of patients was 65 years, and there was a predominance of males (80%), smokers or ex-smokers (90%) and modest alcohol habit (80% negative). Primary tumor localisation was in the medium and distal third of the oesophagus in 57% of the cases, the rest being in the gastro-oesophageal junction. Modest toxicity profiles were observed, with limited incidence of grade 2-3 events. Partial or complete response was observed in more than 90% of the cases (radiological/metabolic) and was confirmed after surgical intervention (67% partial or complete and 27% stable response). Tumor down-staging was recorded in 67% of patients and nodal down-staging in 50%.
  
  
  CONCLUSIONS
  VMAT was applied in the context of neoadjuvant chemoradiotherapy for the treatment of medium and distal oesophageal carcinoma with satisfactory results in terms of tolerance and toxicity.
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy angelo.tozzi@humanitas.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Tozzi
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Iftode
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ascolese
authors.affiliation: Department of Pathology, Humanitas Research Hospital, Milan, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Battista
authors.affiliation: Department of Oncology, Humanitas Research Hospital, Milan, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Cavina
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Clerici
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Comito
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Giuseppe R
authors.initials: GR
authors.lastname: D'Agostino
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Fiorenza
authors.initials: F
authors.lastname: De Rose
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Franzese
authors.affiliation: Department of Oncology, Humanitas Research Hospital, Milan, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Garassino
authors.affiliation: Department of Surgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Uberto Fumagalli
authors.initials: UF
authors.lastname: Romario
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.affiliation: Department of Surgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
authors.affiliation: Department of Pathology, Humanitas Research Hospital, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Spaggiari
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tomatis
authors.affiliation: Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000379:methods; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D004943:Esophagogastric Junction / Q000187:drug effects* / Q000473:pathology / Q000528:radiation effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Oesophageal cancer; RapidArc; neoajuvant radiochemotherapy