Technological advances in radiotherapy for esophageal cancer

Abstract

Radiotherapy with concurrent chemotherapy and surgery represent the main treatment modalities in esophageal cancer. The goal of modern radiotherapy approaches, based on recent technological advances, is to minimize post-treatment complications by improving the gross tumor volume definition (positron emission tomography-based planning), reducing interfraction motion (image-guided radiotherapy) and intrafraction motion (respiratory-gated radiotherapy), and by better dose delivery to the precisely defined planning target volume (intensity-modulated radiotherapy and proton therapy). Reduction of radiotherapy-related toxicity is fundamental to the improvement of clinical results in esophageal cancer, although the dose escalation concept is controversial.

Figure 1

Positron emission tomography/computed tomography images of 61-year-old man with primary squamous cell carcinoma in distal part of the esophagus T3N0M0 prepared in treatment position for radiotherapy planning. A: Computed tomography (CT), axial slice; B: Positron emission tomography (PET), axial slice; C: PET/CT fusion, axial slice; D: CT, sagital slice; E: PET, sagital slice; F: PET/CT fusion, sagital slice.

Figure 2

Intensity-modulated radiotherapy plan prepared on a positron emission tomography/computer tomography dataset (Figure 1). Delineated target volumes and organs at risk, beam arrangement and dose distribution in axial (A), coronal (B), and sagittal slices (C).