Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Dec 5;6(4):2356-68.
doi: 10.3390/cancers6042356.

Analysis of Intensity-Modulated Radiation Therapy (IMRT), Proton and 3D Conformal Radiotherapy (3D-CRT) for Reducing Perioperative Cardiopulmonary Complications in Esophageal Cancer Patients

Ted C Ling  1 , Jerry M Slater  2 , Prashanth Nookala  3 , Rachel Mifflin  4 , Roger Grove  5 , Anh M Ly  6 , Baldev Patyal  7 , Jerry D Slater  2 , Gary Y Yang  8
Affiliations

Analysis of Intensity-Modulated Radiation Therapy (IMRT), Proton and 3D Conformal Radiotherapy (3D-CRT) for Reducing Perioperative Cardiopulmonary Complications in Esophageal Cancer Patients

Ted C Ling et al. Cancers (Basel). .

Abstract

Background. While neoadjuvant concurrent chemoradiotherapy has improved outcomes for esophageal cancer patients, surgical complication rates remain high. The most frequent perioperative complications after trimodality therapy were cardiopulmonary in nature. The radiation modality utilized can be a strong mitigating factor of perioperative complications given the location of the esophagus and its proximity to the heart and lungs. The purpose of this study is to make a dosimetric comparison of Intensity-Modulated Radiation Therapy (IMRT), proton and 3D conformal radiotherapy (3D-CRT) with regard to reducing perioperative cardiopulmonary complications in esophageal cancer patients. Materials. Ten patients with esophageal cancer treated between 2010 and 2013 were evaluated in this study. All patients were simulated with contrast-enhanced CT imaging. Separate treatment plans using proton radiotherapy, IMRT, and 3D-CRT modalities were created for each patient. Dose-volume histograms were calculated and analyzed to compare plans between the three modalities. The organs at risk (OAR) being evaluated in this study are the heart, lungs, and spinal cord. To determine statistical significance, ANOVA and two-tailed paired t-tests were performed for all data parameters. Results. The proton plans showed decreased dose to various volumes of the heart and lungs in comparison to both the IMRT and 3D-CRT plans. There was no difference between the IMRT and 3D-CRT plans in dose delivered to the lung or heart. This finding was seen consistently across the parameters analyzed in this study. Conclusions. In patients receiving radiation therapy for esophageal cancer, proton plans are technically feasible while achieving adequate coverage with lower doses delivered to the lungs and cardiac structures. This may result in decreased cardiopulmonary toxicity and less morbidity to esophageal cancer patients.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(a,b) Heart and lung DVHs.
Figure 2
Figure 2
Coronal and transverse images of 3D-CRT plan (left), IMRT plan (middle), proton plan (right).
See this image and copyright information in PMC

References

    1. Jemal A., Bray F., Center M.M., Ferlay J., Ward E., Forman D. Global cancer statistics. CA Cancer J. Clin. 2011;61:69–90. - PubMed
    1. Gebski V., Burmeister B., Smithers B.M., Foo K., Zalcberg J., Simes J. Australasian Gastro-Intestinal Trials Group. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: A meta-analysis. Lancet Oncol. 2007;8:226–234. - PubMed
    1. Van Hagen P., Hulshof M.C., van Lanschot J.J., Steyerberg E.W., van Berge Henegouwen M.I., Wijnhoven B.P., Richel D.J., Nieuwenhuijzen G.A., Hospers G.A., Bonenkamp J.J., et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N. Engl. J. Med. 2012;366:2074–2084. - PubMed
    1. Ling F.C.F., Durkin A.E., Ferguson M.K. Induction therapy does not increase surgical morbidity after esophagectomy for cancer. Ann. Thoracic Surg. 2004;78:1783–1789. - PubMed
    1. Wang S.L., Liao Z.X., Vaporciyan A.A., Tucker S.L., Liu H., Wei X., Swisher S., Ajani J.A., Cox J.D., Komaki R. Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int. J. Radiat. Oncol. Biol. Phys. 2006;64:692–699. - PubMed

LinkOut - more resources