Back
 IJMPCERO  Vol.8 No.2 , May 2019
Dosimetric Comparison between Three Dimensional Conformal Radiation Therapy (3DCRT) & Intensity Modulated Radiation Therapy (IMRT) in Mid-Lower Oesophageal Carcinoma
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.
Cite this paper: Taher, A. , Elawady, R. and Amin, A. (2019) Dosimetric Comparison between Three Dimensional Conformal Radiation Therapy (3DCRT) & Intensity Modulated Radiation Therapy (IMRT) in Mid-Lower Oesophageal Carcinoma. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 8, 121-129. doi: 10.4236/ijmpcero.2019.82011.
References

[1]   Jemal, A., Siegel, R. and Ward, E. (2008) Cancer Statistic. CA: A Cancer Journal for Clinicians, 58, 71-96. https://doi.org/10.3322/CA.2007.0010

[2]   Kaifi, J.T., Gusani, N.J. and Jiang, Y. (2011) Multidisciplinary Management of Early and Locally Advanced Esophageal Cancer. Journal of Clinical Gastroenterology, 45, 391-399.
https://doi.org/10.1097/MCG.0b013e3182049949

[3]   Tepper, J., Krasna, M.J. and Niedzwiecki, D. (2008) Phase III Trial of Trimodality Therapy with Cisplatin, Fluorouracil, Radiotherapy, and Surgery Compared with Surgery Alone for Esophageal Cancer: CALGB 9781. Journal of Clinical Oncology, 26, 1086-1092.

[4]   Cooper, J., Guo, M., Herskovic, A., Macdonald, J.S., Martenson, J.A. and Al-Sarraf, M. (1999) Chemoradiotherapy of Locally Advanced Esophageal Cancer: Long-Term Follow-Up of a Prospective Randomized Trial (RTOG 85-01). The Journal of the American Medical Association, 281, 1623-1627. https://doi.org/10.1001/jama.281.17.1623

[5]   Fenkell, L., Kaminsky, I., Breen, S., Huang, S., Van Prooijen, M. and Ringash, J. (2008) Dosimetric Comparison of IMRT vs. 3D Conformal Radiotherapy in the Treatment of Cancer of the Cervical Esophagus. Radiotherapy and Oncology, 89, 287-291.
https://doi.org/10.1016/j.radonc.2008.08.008

[6]   Minsky, B., Pajak, T., Ginsberg, R., Pisansky, T.M., Martenson, J. and Komaki, R. (2002) INT 0123 (Radiation Therapy Oncology Group 94-05) Phase III Trial of Combined Modality Therapy for Esophageal Cancer: High-Dose versus Standard-Dose Radiation Therapy. Journal of Clinical Oncology, 20, 1167-1174. https://doi.org/10.1200/JCO.2002.20.5.1167

[7]   Chandra, A., Guerrero, T.M., Liu, H.H., Tucker, S.L., Liao, Z. and Wang, X. (2005) Feasibility of Using Intensity-Modulated Radiotherapy to Improve Lung Sparing in Treatment Planning for Distal Esophageal Cancer. Radiotherapy and Oncology, 77, 247-253.
https://doi.org/10.1016/j.radonc.2005.10.017

[8]   Staffurth, J. and Radiotherapy Development Board (2010) A Review of the Clinical Evidence for Intensity-Modulated Radiotherapy. Clinical Oncology, 22, 643-657.

[9]   Marks, L.B., Yorke, E.D. and Jackson, A. (2010) Use of Normal Tissue Complication Probability Models in the Clinic. International Journal of Radiation Oncology, Biology, Physics, 76, S10-S19. https://doi.org/10.1016/j.ijrobp.2009.07.1754

[10]   Bosset, J., Gignoux, M., Triboulet, J., Tiret, E., Mantion, G. and Elias, D. (1997) Chemoradiotherapy Followed by Surgery Compared with Surgery Alone in Squamous Cell Cancer of the Esophagus. The New England Journal of Medicine, 337, 161-167.
https://doi.org/10.1056/NEJM199707173370304

[11]   Al-Sarraf, M., Martz, K., Herskovic, A., Leichman, L., Brindle, J.S., Vaitkevicius, V.K., et al. (1997) Progress Report of Combined Chemoradiotherapy versus Radiotherapy Alone in Patients with Esophageal Cancer: An Intergroup Study. Journal of Clinical Oncology, 15, 277-284.
https://doi.org/10.1200/JCO.1997.15.1.277

[12]   Ghosh, S., Kapoor, R., Gupta, R., Khosla, D., Kochhar, R., Oinam, A.S., Sharma, R. and Sharma, S.C. (2012) An Evaluation of Three Dimensional Conformal Radiation Therapy versus Intensity Modulated Radiation Therapy in Radical Chemoradiation of Esophageal Cancer: A Dosimetric Study. Clinical Cancer Investigation Journal, 1, 65-70.
https://doi.org/10.4103/2278-0513.99565

[13]   Wu, Z., Xie, C., Hu, M., Han, C. and Yi, J. (2014) Dosimetric Benefits of IMRT and VMAT in the Treatment of Middle Thoracic Esophageal Cancer: Is the Conformal Radiotherapy Still an Alternative Option? Journal of Applied Clinical Medical Physics, 15, 93-101.

[14]   Nutting, C.M., Dearnalay, D.P. and Webb, S. (2000) Intensity Modulated Radiation Therapy: A Clinical Review. The British Journal of Radiology, 73, 459-469.
https://doi.org/10.1259/bjr.73.869.10884741

[15]   Vivekanandan, N., Sriram, P., Kumar, S., Bhuvaneswari, N. and Saranya, K. (2012) Volumetric Modulated Arc Radiotherapy for Esophageal Cancer. Medical Dosimetry, 37, 108-113.
https://doi.org/10.1016/j.meddos.2011.01.008

[16]   Khoo, V.S., Oldham, M., Adams, E.J., Bedford, J.L., Webb, S. and Brada, M. (1999) Comparison of Intensity-Modulated Tomotherapy with Stereotactically Guided Conformal Radiotherapy for Brain Tumors. International Journal of Radiation Oncology, Biology, Physics, 45, 415-425.
https://doi.org/10.1016/S0360-3016(99)00213-8

[17]   Cheung, K.Y. (2006) Intensity Modulated Radiotherapy: Advantages, Limitations and Future Developments. Biomedical Imaging and Intervention Journal, 2, e19.
https://doi.org/10.2349/biij.2.1.e19

[18]   Yong, J.H.E., McGowan, T., Redmond-Misner, R., et al. (2016) Estimating the Costs of Intensity-Modulated and 3-Dimensional Conformal Radiotherapy in Ontario. Cancer Research, 23, 228-238. https://doi.org/10.3747/co.23.2998

[19]   Nutting, C.M., Bedford, J.L., Cosgrove, V.P., Tait, D.M., Dearnaley, D.P. and Webb, S. (2001) A Comparison of Conformal and Intensity-Modulated Techniques for Oesophageal Radiotherapy. Radiotherapy and Oncology, 61, 157-163. https://doi.org/10.1016/S0167-8140(01)00438-8

[20]   Chen, Y.J., Liu, A. and Han, C. (2007) Helical Tomotherapy for Radiotherapy in Esophageal Cancer: A Preferred Plan with Better Conformal Target Coverage and More Homogeneous Dose Distribution. Medical Dosimetry, 32, 166-171. https://doi.org/10.1016/j.meddos.2006.12.003

[21]   Mayo, C.S., Urie, M.M., Fitzgerald, T.J., Ding, L., Lo, Y.C. and Bogdanov, M. (2008) Hybrid IMRT for Treatment of Cancers of the Lung and Esophagus. International Journal of Radiation Oncology, Biology, Physics, 71, 1408-1418. https://doi.org/10.1016/j.ijrobp.2007.12.008

 
 
Top