Abstract
Objective: To explore an adequate treatment method and provide a better irradiation mode for upper, and mid, esophageal carcinoma radiotherapy by comparing the dose distributions of six different semi-field radiotherapy options.Methods: Twenty patients with upper, and mid, esophageal carcinoma were selected for six treatment options, three [Options D-F] were semi-field irradiation: Option A-conventional 5-field three-dimensional conformal radiation therapy (3D-CRT); option B-conventional 5-field intensity modulated radiation therapy (IMRT); option C-conventional 3-field IMRT; option D-5-field IMRT (upper target) and 3-field conformal radiation therapy (lower target); option E-5-field IMRT (upper target) and 3- field IMRT (lower target); and, option F-5-field IMRT (upper target) and 5-field IMRT (lower target). Dose distribution in the target areas and dose distribution in normal tissue were compared for the six options.Results: Target coverage by the semi-field techniques was effective in a comparison of the six options. Lung low-dose area and mean lung dose (MLD) were lower in Options D and E. Option E conformal index in was higher than Option D.Conclusion: Options D and E appear to be two relatively advantageous options as they allow effective delivery of the prescribed dose to the target volumes while minimizing the lung tissue exposure to low doses.
Highlights
The radiotherapy target for upper, and middle, esophageal carcinoma spans the thoracic inlet
Anatomical characteristics cause target depths to vary significantly, resulting in uneven target dose distributions in radiotherapy and excessive exposure dose in normal tissues, especially the lungs. It is difficult for three-dimension-conformal radiotherapy (3D-CRT) to avoid vital organs, such as the spinal cord and lungs, while at the same time improving the target dose
Gross tumor volume (GTV) on computed tomography (CT) planning is defined as the tumor extension (GTVt) and lymphadenopathies (GTVnd) that can be seen via diagnosis, staging imagology, and endoscopy
Summary
The radiotherapy target for upper, and middle, esophageal carcinoma spans the thoracic inlet. Anatomical characteristics cause target depths to vary significantly, resulting in uneven target dose distributions in radiotherapy and excessive exposure dose in normal tissues, especially the lungs. It is difficult for three-dimension-conformal radiotherapy (3D-CRT) to avoid vital organs, such as the spinal cord and lungs, while at the same time improving the target dose. This study attempted to decrease lung tissue low-dose exposure areas and reduce the incidence of radiation pneumonitis by using a semi-field IMRT technique. It is a new technique for esophageal cancer treatment that has not yet, to our knowledge, been described in the literature. The aim is to provide a theoretical foundation for applying mono-isocenter upper and lower semi-field techniques via a dose comparison of different radiotherapy planning techniques
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