Helical Tomotherapy For Radiochemotherapy In Esophageal Cancer: A Preferred Plan?

摘要

The addition of systemic chemotherapy to local radiationfortherapy in the non-surgicalHowever, ment of esophageal cancer has offered the opportunity long-term survival (1). this survival benefit has come at the cost of increased side effects. The standard dose of radiation remains up to 50 Gy in the definitive or pre-operative setting despite previous attempts to dose escalate (2). Even at this modest dose, the majority of concurrent chemoradiation patients experience grade 3 or higher toxicities when utilizing conventional radiation techniques. When concurrent chemotherapy and radiation are delivered neoadjuvantly, the combination appears to increase resectability, produce tumor downstaging and may impact local control, disease-free survival, and overall survival (3-5). This tri-modality approach, while relatively effective, has been shown with peri-operative rates of toxicity of 11-12% (6). The esophagus is a centrally located structure, surrounded by the lungs, normal esophagus, heart and spinal cord. For the treating radiation oncologist, achieving adequate dose to the gross tumor volume and adjacent clinical targets while limiting dose to the surrounding critical normal tissues represents a therapeutic challenge.