title: Feasibility of intensity-modulated radiotherapy for esophageal cancer in definite chemoradiotherapy.
abstract: BACKGROUND
  Esophageal cancer is a highly lethal malignancy, and its treatment has undergone a major evolution over the past 15 years. The objective of this study was to report our experience on the efficacy of definite chemoradiotherapy with the intensity-modulated radiotherapy (IMRT) technique in treating locally advanced esophageal cancer.
  
  
  METHODS
  From September 2004 to November 2011, 39 patients with biopsy-proven esophageal cancer, clinical stage T1-4N0-3M0 according to the American Joint Committee on Cancer 7(th) edition were enrolled. In these enrolled cases, either the tumor was unresectable or the patients refused surgery. All patients received a total radiation dose of 40-56 Gy in 20-28 fractions using IMRT planning. Five to seven radiation beam angles were designed according to the specific shape of the clinical target volume (CTV) and were delivered by a linear accelerator with photons of 6-10 MV energy. The gross tumor volume, CTV, planning target volume, and the organs at risk were outlined, and the homogeneity index (HI) and the conformity index (CI) were calculated. The treatment-related toxicities were also reviewed.
  
  
  RESULTS
  The mean follow-up time was 22.4 months (range, 2.0-91.0 months). The 2- and 3-year overall survival rates were 30% and 28%, respectively. The most common Grade 3/4 toxicity was hematologic toxicity (43.6%). The IMRT plans showed high-dose homogeneity to the target, with a calculated HI of 0.9. The calculated CI of 0.8 also showed high conformity treatment dose to target within an acceptable dose range. For the total lungs, the average mean dose was 1313.7 cGy. The V5 and V20 of the total lungs were 67.8% and 23.4%, respectively. For the heart, the average mean dose was 2319.2 cGy. The V30 and V35 of the heart were 30.2% and 21.5%, respectively.
  
  
  CONCLUSIONS
  Concurrent chemoradiotherapy using the IMRT technique for treating locally advanced unresectable esophageal cancer is feasible, with better conformity of target volume as well as improved sparing of organs at risk.
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: He-Yuan
authors.initials: HY
authors.lastname: Hsieh
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC. Electronic address: hlyeh@vghtc.gov.tw.
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Yeh
authors.affiliation: Division of Thoracic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Chung-Ping
authors.initials: CP
authors.lastname: Hsu
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Jin-Ching
authors.initials: JC
authors.lastname: Lin
authors.affiliation: Division of Thoracic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Cheng-Yen
authors.initials: CY
authors.lastname: Chuang
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Jai-Fu
authors.initials: JF
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Chen-Fa
authors.initials: CF
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008168:Lung / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects
keywords: chemoradiotherapy; esophageal carcinoma; intensity-modulated radiotherapy