Abstract
Purpose: To investigate if intensity modulated radiation therapy (IMRT) offers a better planning target volume (PTV) coverage and/or lower dose to normal thoracic structures in comparison to three dimensional conformal radiation therapy (3DCRT) in the treatment of mid and lower oesophageal carcinoma patients. Materials and Methods: A prospective study in the period from 2014 till 2015 was held in the radiation therapy department of the National Cancer Institute, Cairo University, in which 20 locally advanced or inoperable mid and lower oesophageal cancer patients were treated by chemo-radiation using 3DCRT technique. IMRT plans were generated for those 20 patients. The 3DCRT and IMRT plans were compared as regards PTV coverage and doses to critical organs at risk. Results: All plans had produced satisfactory PTV coverage with no significant differences noted. The lung V20 for both lungs in 3DCRT was 16.94% ± 4.2% which was increased to 21.42% ± 3.6% in IMRT (p = 0.017). The mean dose to the heart and V30 were higher in IMRT plans while the mean dose to the spinal cord was higher with 3DCRT plans, yet that didn’t reach a statistically significant level (p = 0.156). The dose delivered to the liver didn’t pose any difference between both techniques. Conclusion: 3DCRT remains to be a feasible cost effective treatment delivery option for mid and lower oesophageal cancer cases with a lower optimization and delivery time than that for IMRT. Moreover, that calls for further dosimetric studies and clinical trials to assess IMRT technique. In our study, IMRT using nine fields didn’t prove to be superior to 3DCRT.
Highlights
Oesophageal cancer continues to rank as one of the highly aggressive and lethal gastrointestinal diseases globally [1]
The mean dose to the heart and V30 were higher in intensity modulated radiation therapy (IMRT) plans while the mean dose to the spinal cord was higher with 3D conformal radiation therapy (3DCRT) plans, yet that didn’t reach a statistically significant level (p = 0.156)
The 3DCRT and IMRT plans were dosimetrically evaluated, dose coverage to planning target volume (PTV) all techniques achieved the constraint that 95% of the volume is covered by more than 95% of the prescribed dose
Summary
Oesophageal cancer continues to rank as one of the highly aggressive and lethal gastrointestinal diseases globally [1]. Poor treatment outcomes continue to challenge the multidisciplinary array of surgeons, medical and radiation oncologists. Most patients are present in an advanced or an unresectable stage [2]. This fact has led to the establishment of concurrent chemo radiotherapy (CCRT) as the staple treatment policy for such cases [3]. The technique of radiation therapy delivery has evolved along the years starting with the basic antero-posterior/postero-anterior (AP/PA) field arrangement, the 4 fields box technique reducing the lateral fields’ weight to decrease dose to lungs, as well as the 3-field technique; anteroposterior field and 2 posterior oblique fields. Up until the era of the 3D conformal radiation therapy (3DCRT) has become the technique of choice for many years in various centers [5]
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