Comparison of heart and coronary artery doses associated with intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for distal esophageal cancer Journal Article


Authors: Kole, T. P.; Aghayere, O.; Kwah, J.; Yorke, E. D.; Goodman, K. A.
Article Title: Comparison of heart and coronary artery doses associated with intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for distal esophageal cancer
Abstract: Purpose: To compare heart and coronary artery radiation exposure using intensity-modulated radiotherapy (IMRT) vs. four-field three-dimensional conformal radiotherapy (3D-CRT) treatment plans for patients with distal esophageal cancer undergoing chemoradiation. Methods and Materials: Nineteen patients with distal esophageal cancers treated with IMRT from March 2007 to May 2008 were identified. All patients were treated to 50.4 Gy with five-field IMRT plans. Theoretical 3D-CRT plans with four-field beam arrangements were generated. Dose-volume histograms of the planning target volume, heart, right coronary artery, left coronary artery, and other critical normal tissues were compared between the IMRT and 3D-CRT plans, and selected parameters were statistically evaluated using the Wilcoxon rank-sum test. Results: Intensity-modulated radiotherapy treatment planning showed significant reduction (p < 0.05) in heart dose over 3D-CRT as assessed by average mean dose (22.9 vs. 28.2 Gy) and V30 (24.8% vs. 61.0%). There was also significant sparing of the right coronary artery (average mean dose, 23.8 Gy vs. 35.5 Gy), whereas the left coronary artery showed no significant improvement (mean dose, 11.2 Gy vs. 9.2 Gy), p = 0.11. There was no significant difference in percentage of total lung volume receiving at least 10, 15, or 20 Gy or in the mean lung dose between the planning methods. There were also no significant differences observed for the kidneys, liver, stomach, or spinal cord. Intensity-modulated radiotherapy achieved a significant improvement in target conformity as measured by the conformality index (ratio of total volume receiving 95% of prescription dose to planning target volume receiving 95% of prescription dose), with the mean conformality index reduced from 1.56 to 1.30 using IMRT. Conclusions: Treatment of patients with distal esophageal cancer using IMRT significantly decreases the exposure of the heart and right coronary artery when compared with 3D-CRT. Long-term studies are necessary to determine how this will impact on development of coronary artery disease and other cardiac complications. © 2012 Elsevier Inc. All rights reserved.
Keywords: adult; clinical article; aged; aged, 80 and over; middle aged; retrospective studies; three dimensional; intensity modulated radiation therapy; treatment planning; cancer radiotherapy; radiation dose; radiotherapy dosage; radiotherapy; clinical assessment; tomography, x-ray computed; retrospective study; late effects; liver; kidney; intensity-modulated radiotherapy; physical therapy; radiotherapy, intensity-modulated; dosimetry; spinal cord; lung; radiation injuries; radiotherapy planning, computer-assisted; radiotherapy, conformal; computer assisted radiotherapy; esophagus cancer; coronary vessels; biological organs; heart; diseases; esophageal neoplasms; chemoradiotherapy; esophageal cancer; stomach; tissue; histogram; esophagogastric junction; statistical tests; lung volume; dose-volume effects; three dimensional conformal radiotherapy; left coronary artery; organs at risk; cardiac dose; cardiac resynchronization therapy; distal esophagus cancer; right coronary artery
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 83
Issue: 5
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2012-08-01
Start Page: 1580
End Page: 1586
Language: English
DOI: 10.1016/j.ijrobp.2011.10.053
PROVIDER: scopus
PUBMED: 22284687
DOI/URL:
Notes: --- - "Export Date: 1 August 2012" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Karyn A Goodman
    244 Goodman
  2. Ellen D Yorke
    314 Yorke
  3. Jason Kwah
    2 Kwah
  4. Thomas Kole
    1 Kole
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