Gou CX, Zheng AM, Song HX, Gou QY, Tao N. Multimodal image-guided volumetric modulated arc radiotherapy for postoperative esophageal cancer: A prospective randomized controlled trial. World J Gastrointest Surg 2026; 18(10): 123247 [DOI: 10.4240/wjgs.123247]
Corresponding Author of This Article
Hai-Xia Song, Department of Radiotherapy, Gansu Provincial Cancer Hospital, No. 2 Xiaoxihu East Street, Qilihe District, Lanzhou 730000, Gansu Province, China. songhaixiahx@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
research-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Oct 27, 2026; 18(10): 123247 Published online Oct 27, 2026. doi: 10.4240/wjgs.123247
Multimodal image-guided volumetric modulated arc radiotherapy for postoperative esophageal cancer: A prospective randomized controlled trial
Cai-Xia Gou, An-Mei Zheng, Hai-Xia Song, Qiu-Yan Gou, Na Tao
Cai-Xia Gou, An-Mei Zheng, Hai-Xia Song, Qiu-Yan Gou, Na Tao, Department of Radiotherapy, Gansu Provincial Cancer Hospital, Lanzhou 730000, Gansu Province, China
Co-first authors: Cai-Xia Gou and An-Mei Zheng.
Author contributions: Gou CX performed the majority of experiments and wrote the manuscript; Zheng AM designed the study and corrected the manuscript; Gou CX and Zheng AM contributed equally to this manuscript and are co-first authors; Song HX participated in the collection of the human material; Gou QY and Tao N served as scientific advisors. All authors approval the final manuscript.
AI contribution statement: This manuscript has not been generated with the use of AI tools.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Gansu Provincial Cancer Hospital.
Clinical trial registration statement: This was a prospective, randomized, controlled trial that investigated the effects of magnetic resonance imaging/computed tomography multimodal image-guided radiotherapy in the treatment of esophageal cancer. The intervention consisted exclusively of optimized radiotherapy practices (e.g., magnetic resonance imaging/computed tomography multimodal image localization, precise dose adjustment, and real-time efficacy monitoring) and did not involve any additional invasive procedures or deviations from standard medical care. Therefore, it did not increase the risk beyond that associated with routine treatment. This study was reviewed and approved by the hospital’s ethics committee. As it was classified as a preliminary exploratory study focused on verifying technical efficacy and did not fall within the scope of an interventional clinical trial, it was not registered with the Chinese Clinical Trial Registry.
Informed consent statement: All patients provided informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author.
Corresponding author: Hai-Xia Song, Department of Radiotherapy, Gansu Provincial Cancer Hospital, No. 2 Xiaoxihu East Street, Qilihe District, Lanzhou 730000, Gansu Province, China. songhaixiahx@163.com
Received: May 15, 2026 Revised: June 16, 2026 Accepted: July 16, 2026 Published online: October 27, 2026 Processing time: 148 Days and 22.6 Hours
Abstract
BACKGROUND
Postoperative radiotherapy for esophageal cancer presents challenges in target delineation and normal tissue sparing because of surgical changes. Volumetric modulated arc therapy (VMAT) combined with multimodal image guidance may improve precision.
AIM
To evaluate the efficacy of multimodal magnetic resonance imaging (MRI)/computed tomography (CT)-guided VMAT compared with CT-guided radiotherapy in patients undergoing postoperative treatment for esophageal cancer.
METHODS
This prospective randomized controlled trial enrolled 65 patients with postoperative esophageal cancer, who were assigned to either an experimental group (MRI/CT-guided VMAT, n = 32) or a control group (CT-guided radiotherapy alone, n = 33). Dose distribution, dose-delivery accuracy, short-term efficacy, and adverse reactions were compared between groups.
RESULTS
The experimental group demonstrated a significantly lower mean daily dose deviation (difference between planned and delivered dose) than the control group (2.3% ± 0.5% vs 4.6% ± 0.7%, P < 0.01). The standard deviation of dose deviation was also significantly lower (1.1% ± 0.3% vs 2.4% ± 0.4%, P < 0.01). For short-term clinical outcomes at 6 months, the complete remission rate was significantly higher in the experimental group than in the control group (65.6% vs 36.4%, P < 0.05). Similarly, the overall response rate (complete remission + partial remission) was significantly higher in the experimental group (90.6% vs 69.7%, P < 0.05). Acute esophagitis (31.3% vs 54.5%, P < 0.05) and late cardiac injury (12.5% vs 27.3%, P < 0.05) were significantly lower in the experimental group.
CONCLUSION
Compared with conventional CT-guided radiotherapy, multimodal MRI/CT-guided VMAT significantly improves dose-delivery accuracy, short-term tumor control, and safety in postoperative radiotherapy for esophageal cancer.
