Abstract
Background. While neoadjuvant concurrent chemoradiotherapy has improved outcomes for esophageal cancer patients, surgical complication rates remain high. The most frequent perioperative complications after trimodality therapy were cardiopulmonary in nature. The radiation modality utilized can be a strong mitigating factor of perioperative complications given the location of the esophagus and its proximity to the heart and lungs. The purpose of this study is to make a dosimetric comparison of Intensity-Modulated Radiation Therapy (IMRT), proton and 3D conformal radiotherapy (3D-CRT) with regard to reducing perioperative cardiopulmonary complications in esophageal cancer patients. Materials. Ten patients with esophageal cancer treated between 2010 and 2013 were evaluated in this study. All patients were simulated with contrast-enhanced CT imaging. Separate treatment plans using proton radiotherapy, IMRT, and 3D-CRT modalities were created for each patient. Dose-volume histograms were calculated and analyzed to compare plans between the three modalities. The organs at risk (OAR) being evaluated in this study are the heart, lungs, and spinal cord. To determine statistical significance, ANOVA and two-tailed paired t-tests were performed for all data parameters. Results. The proton plans showed decreased dose to various volumes of the heart and lungs in comparison to both the IMRT and 3D-CRT plans. There was no difference between the IMRT and 3D-CRT plans in dose delivered to the lung or heart. This finding was seen consistently across the parameters analyzed in this study. Conclusions. In patients receiving radiation therapy for esophageal cancer, proton plans are technically feasible while achieving adequate coverage with lower doses delivered to the lungs and cardiac structures. This may result in decreased cardiopulmonary toxicity and less morbidity to esophageal cancer patients.
Highlights
Esophageal cancer is a highly aggressive malignancy that accounts for over 400,000 deaths worldwide [1].Data have demonstrated that neoadjuvant concurrent chemoradiotherapy improves local control and survival compared with surgery alone [2,3,4]
Three treatment plans were created on each scan: proton, Intensity-Modulated Radiation Therapy (IMRT), and 3D conformal radiotherapy (3D-CRT)
The proton plans resulted in lower mean lung dose (6.03 Gy vs. 9.45 Gy, p = 0.016), lung V5 (21.4% vs. 46.93%, p = 0.001), V10 (19.37% vs. 37.75%, p = 0.003), V15 (17.29% vs. 27.89%, p = 0.009), mean liver dose
Summary
Esophageal cancer is a highly aggressive malignancy that accounts for over 400,000 deaths worldwide [1].Data have demonstrated that neoadjuvant concurrent chemoradiotherapy improves local control and survival compared with surgery alone [2,3,4]. Been demonstrated as an independent predictor of perioperative cardiopulmonary complications. There is very little existing dose-volume histogram data for cardiac structures such as the left ventricle and pericardium, with regard to proton radiotherapy for esophageal cancer. While neoadjuvant concurrent chemoradiotherapy has improved outcomes for esophageal cancer patients, surgical complication rates remain high. The radiation modality utilized can be a strong mitigating factor of perioperative complications given the location of the esophagus and its proximity to the heart and lungs. Radiation Therapy (IMRT), proton and 3D conformal radiotherapy (3D-CRT) with regard to reducing perioperative cardiopulmonary complications in esophageal cancer patients. Ten patients with esophageal cancer treated between 2010 and 2013 were evaluated in this study. Separate treatment plans using proton radiotherapy, IMRT, and 3D-CRT modalities were created for each patient.
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