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World J Gastroenterol. Sep 14, 2006; 12(34): 5501-5508
Published online Sep 14, 2006. doi: 10.3748/wjg.v12.i34.5501
Intensity-modulated radiation therapy with concurrent chemotherapy for locally advanced cervical and upper thoracic esophageal cancer
Shu-Lian Wang, Zhongxing Liao, Helen Liu, Jaffer Ajani, Stephen Swisher, James D Cox, Ritsuko Komaki
Shu-Lian Wang, Department of Radiation Oncology, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
Zhongxing Liao, Helen Liu, James D Cox, Ritsuko Komaki, Department of Radiation Oncology, the University of Texas M D Anderson Cancer Center, United States
Jaffer Ajani, Department of Gastrointestinal Medical Oncology, the University of Texas M D Anderson Cancer Center, United States
Stephen Swisher, Department of Cardiovascular and Thoracic Surgical Oncology, the University of Texas M D Anderson Cancer Center, United States
Supported by Radiology Society of Northern America Researh and Education Program, Grant to “Teach the Teachers” from Emerging Nations
Correspondence to: Zhongxing Liao, MD, Department of Radiation Oncology, the University of Texas M D Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 97, Houston, TX 77030, United States. zliao@mdanderson.org
Telephone: +1-713-56302300 Fax: +1-713-5632366
Received: December 14, 2005
Revised: December 28, 2005
Accepted: May 23, 2006
Published online: September 14, 2006
Abstract

AIM: To evaluate the dosimetry, efficacy and toxicity of intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy for patients with locally advanced cervical and upper thoracic esophageal cancer.

METHODS: A retrospective study was performed on 7 patients who were definitively treated with IMRT and concurrent chemotherapy. Patients who did not receive IMRT radiation and concurrent chemotherapy were not included in this analysis. IMRT plans were evaluated to assess the tumor coverage and normal tissue avoidance. Treatment response was evaluated and toxicities were assessed.

RESULTS: Five- to nine-beam IMRT were used to deliver a total dose of 59.4-66 Gy (median: 64.8 Gy) to the primary tumor with 6-MV photons. The minimum dose received by the planning tumor volume (PTV) of the gross tumor volume boost was 91.2%-98.2% of the prescription dose (standard deviation [SD]: 3.7%-5.7%). The minimum dose received by the PTV of the clinical tumor volume was 93.8%-104.8% (SD: 4.3%-11.1%) of the prescribed dose. With a median follow-up of 15 mo (range: 3-21 mo), all 6 evaluable patients achieved complete response. Of them, 2 developed local recurrences and 2 had distant metastases, 3 survived with no evidence of disease. After treatment, 2 patients developed esophageal stricture requiring frequent dilation and 1 patient developed tracheal-esophageal fistula.

CONCLUSION: Concurrent IMRT and chemotherapy resulted in an excellent early response in patients with locally advanced cervical and upper thoracic esophageal cancer. However, local and distant recurrence and toxicity remain to be a problem. Innovative approaches are needed to improve the outcome.

Keywords: Esophageal cancer; Intensity-modulated radiation therapy; Chemotherapy