title: Different definitions of esophagus influence esophageal toxicity prediction for esophageal cancer patients administered simultaneous integrated boost versus standard-dose radiation therapy.
abstract: We aim to evaluate whether different definitions of esophagus (DEs) impact on the esophageal toxicity prediction for esophageal cancer (EC) patients administered intensity-modulated radiation therapy with simultaneous integrated boost (SIB-IMRT) vs. standard-dose IMRT (SD-IMRT). The esophagus for 21 patients diagnosed with primary EC were defined in the following four ways: the whole esophagus, including the tumor (ESOwhole); ESOwholewithin the treatment field (ESOinfield); ESOinfield, excluding the tumor (ESOinfield-tumor) and ESOwhole, excluding the tumor (ESOwhole-tumor). The difference in the dose variation, acute esophageal toxicity (AET) and late esophageal toxicity (LET) of four DEs were compared. We found that the mean esophageal dose for ESOwhole, ESOinfield, ESOinfield-tumorand ESOwhole-tumorwere increased by 7.2 Gy, 10.9 Gy, 4.6 Gy and 2.0 Gy, respectively, in the SIB-IMRT plans. Radiobiological models indicated that a grade ≥ 2 AET was 2.9%, 3.1%, 2.2% and 1.6% higher on average with the Kwint model and 14.6%, 13.2%, 7.2% and 3.4% higher with the Wijsman model for the four DEs. A grade ≥ 3 AET increased by 4.3%, 7.2%, 4.2% and 1.2%, respectively. Additionally, the predicted LET increased by 0.15%, 0.39%, 1.2 × 10-2% and 1.5 × 10-3%. Our study demonstrates that different DEs influence the esophageal toxicity prediction for EC patients administered SIB-IMRT vs. SD-IMRT treatment.
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
authors.forename: Bao-Tian
authors.initials: BT
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
authors.forename: Rui-Hong
authors.initials: RH
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
authors.forename: Wu-Zhe
authors.initials: WZ
authors.lastname: Zhang
authors.affiliation: Department of Respiratory Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
authors.forename: Long-Jia
authors.initials: LJ
authors.lastname: Guo
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
authors.forename: Liang-Yu
authors.initials: LY
authors.lastname: Xu
authors.affiliation: Department of Nosocomial Infection Management, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China.
authors.forename: Pei-Xian
authors.initials: PX
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.|CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK.
authors.forename: Jian-Zhou
authors.initials: JZ
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
authors.forename: De-Rui
authors.initials: DR
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China. stccz@139.com.
authors.forename: Chuang-Zhen
authors.initials: CZ
authors.lastname: Chen
mesh_terms: D000368:Aged; D003198:Computer Simulation; D004938:Esophageal Neoplasms / Q000532:radiotherapy*; D004947:Esophagus / Q000528:radiation effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D009626:Terminology as Topic