Background and objective: Intensity-modulated radiotherapy (IMRT) for esophageal carcinoma has seldom been reported; its clinical efficacy and toxicity are still uncertain. This study was to evaluate the short-term efficacy of IMRT on esophageal carcinoma, and to observe adverse events.
Methods: From June 2006 to March 2008, 37 patients with cervical and thoracic esophageal carcinoma were treated with IMRT. The treatment response, local control and survival were evaluated and the adverse events were observed.
Results: The minimal prescription dose of 100% of gross tumor volume (GTV D100) 95% of clinical target volume (CTV D95), and 95% of planning target volume (PTV D95) were (6 456+/-172)cGy, (6 293+/-145)cGy, and (5 988+/-53)cGy, respectively. The volumes of lung receiving irradiation of >or= 5 Gy, >or=10 Gy, >or=20 Gy and >or=30 Gy were (59.6+/-12.8)%, (39.5+/-8.7)%, (22.0+/-5.4)%, and (12.0+/-4.3)%, respectively. The mean lung dose (MLD) was (1 178+/-248)cGy. The overall response rate was 97.3% (36/37). The patients were followed-up for 8-29 months (median,13 months). The occurrence rates of grades 3-4 acute and late esophagitis, grades 2-4 acute and late pneumonitis were 16.2% and 7.2%, 10.8% and 8.1%. The 1-and 2-year local control rates were 72.9% and 72.9%. The 1-and 2-year overall survival rates were 80.9% and 67.4%. The 1-and 2-year disease-free survival rates were 73.5% and 51.4%. Local recurrence (69.2%) was the main reason of treatment failure.
Conclusion: IMRT is an effective treatment for esophageal carcinoma with low occurrence of acute and late radiation-related pneumonitis, but local failure is still a main problem for treatment of patients with esophageal carcinoma.