open access

Vol 20, No 2 (2015)
Original research articles
Published online: 2015-03-01
Submitted: 2014-07-24
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Is dose escalation achievable for esophageal carcinoma?

Laure Vieillevigne, Marie Vidal, Françoise Izar, Michel Rives
DOI: 10.1016/j.rpor.2014.12.006
·
Rep Pract Oncol Radiother 2015;20(2):135-140.

open access

Vol 20, No 2 (2015)
Original research articles
Published online: 2015-03-01
Submitted: 2014-07-24

Abstract

Aim

To investigate the feasibility of dose escalation using rapid arc (RA) and Helical Tomotherapy (HT) for patients with upper, middle and distal esophageal carcinomas, even for large tumor volumes.

Background

In esophageal cancer, for patients with exclusive radio-chemotherapy, local disease control remains poor. Planning study with dose escalation was done for two sophisticated modulated radiotherapy techniques: Rapid arc against Tomotherapy.

Materials and methods

Six patients treated with a RA simultaneous integrated boost (SIB) of 60[[ce:hsp sp="0.25"/]]Gy were re-planned for RA and HT techniques with a SIB dose escalated to 70[[ce:hsp sp="0.25"/]]Gy. Dose volume histogram statistics, conformity indices and homogeneity indices were analyzed. For a given set of normal tissue constraints, the capability of each treatment modality to increase the GTV dose to 70[[ce:hsp sp="0.25"/]]Gy was investigated.

Results

Either HT or VMAT may be used to escalate the dose delivered in esophageal tumors while maintaining the spinal cord, lung and heart doses within tolerance. Adequate target coverage was achieved by both techniques. Typically, HT achieved better lung sparing and PTV coverage than did RA.

Conclusions

Dose escalation for esophageal cancer becomes clinically feasible with the use of RA and HT. This promising result could be explored in a carefully controlled clinical study which considered normal tissue complications and tumor control as endpoints.

Abstract

Aim

To investigate the feasibility of dose escalation using rapid arc (RA) and Helical Tomotherapy (HT) for patients with upper, middle and distal esophageal carcinomas, even for large tumor volumes.

Background

In esophageal cancer, for patients with exclusive radio-chemotherapy, local disease control remains poor. Planning study with dose escalation was done for two sophisticated modulated radiotherapy techniques: Rapid arc against Tomotherapy.

Materials and methods

Six patients treated with a RA simultaneous integrated boost (SIB) of 60[[ce:hsp sp="0.25"/]]Gy were re-planned for RA and HT techniques with a SIB dose escalated to 70[[ce:hsp sp="0.25"/]]Gy. Dose volume histogram statistics, conformity indices and homogeneity indices were analyzed. For a given set of normal tissue constraints, the capability of each treatment modality to increase the GTV dose to 70[[ce:hsp sp="0.25"/]]Gy was investigated.

Results

Either HT or VMAT may be used to escalate the dose delivered in esophageal tumors while maintaining the spinal cord, lung and heart doses within tolerance. Adequate target coverage was achieved by both techniques. Typically, HT achieved better lung sparing and PTV coverage than did RA.

Conclusions

Dose escalation for esophageal cancer becomes clinically feasible with the use of RA and HT. This promising result could be explored in a carefully controlled clinical study which considered normal tissue complications and tumor control as endpoints.

Get Citation

Keywords

Rapid arc; Tomotherapy; Dose escalation; Esophageal cancer

About this article
Title

Is dose escalation achievable for esophageal carcinoma?

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 20, No 2 (2015)

Pages

135-140

Published online

2015-03-01

DOI

10.1016/j.rpor.2014.12.006

Bibliographic record

Rep Pract Oncol Radiother 2015;20(2):135-140.

Keywords

Rapid arc
Tomotherapy
Dose escalation
Esophageal cancer

Authors

Laure Vieillevigne
Marie Vidal
Françoise Izar
Michel Rives

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