Incidental nodal irradiation in patients with esophageal cancer undergoing (chemo)radiation with 3D-CRT or VMAT
Abstract The extent of elective nodal irradiation (ENI) in patients undergoing definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC) remains unclear. The aim of this dosimetric study was to evaluate the extent of incidental nodal irradiation using modern radiation techniq...
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Nature Portfolio
2022-12-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-022-26641-w |
| _version_ | 1797977458081792000 |
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| author | David Paul Peschel Mathias Düsberg Jan C. Peeken Jan Christian Kaiser Kai Joachim Borm Katharina Sommer Stephanie E. Combs Stefan Münch |
| author_facet | David Paul Peschel Mathias Düsberg Jan C. Peeken Jan Christian Kaiser Kai Joachim Borm Katharina Sommer Stephanie E. Combs Stefan Münch |
| author_sort | David Paul Peschel |
| collection | DOAJ |
| description | Abstract The extent of elective nodal irradiation (ENI) in patients undergoing definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC) remains unclear. The aim of this dosimetric study was to evaluate the extent of incidental nodal irradiation using modern radiation techniques. A planning target volume (PTV) was generated for 30 patients with node-negative esophageal carcinoma (13 cervical/upper third, 7 middle third, 10 lower third/abdomen). Thereby, no elective nodal irradiation (ENI) was intended. Both three-dimensional conformal radiotherapy (3D-CRT) and volumetric-modulated arc therapy (VMAT) treatment plans (50 Gy in 25 fractions) were calculated for all patients. Fifteen nodal stations were contoured according to the definitions of the AJCC and investigated in regard to dosimetric parameters. Compared to 3D-CRT, VMAT was associated with lower dose distribution to the organs at risk (lower Dmean, V20 and V30 for the lungs and lower Dmean and V30 for the heart). For both techniques, the median Dmean surpassed 40 Gy in 12 of 15 (80%) nodal stations. However, VMAT resulted in significantly lower Dmeans and equivalent uniform doses (EUD) compared to 3D-CRT for eight nodal stations (1L, 2L, 2R, 4L, 7, 8L, 10L, 15), while differences did not reach significance for seven nodal station (1R, 4R, 8U, 8M, 10R, 16). For dCRT of ESCC, the use of VMAT was associated with significantly lower median (incidental) doses to eight of 15 regional lymph node areas compared to 3D-CRT. However, given the small absolute differences, these differences probably do not impair (regional) tumor control rates. |
| first_indexed | 2024-04-11T05:07:13Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-11T05:07:13Z |
| publishDate | 2022-12-01 |
| publisher | Nature Portfolio |
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| spelling | doaj.art-30e5aa1f3a6d4ca9bb5d01806265131f2022-12-25T12:15:44ZengNature PortfolioScientific Reports2045-23222022-12-011211910.1038/s41598-022-26641-wIncidental nodal irradiation in patients with esophageal cancer undergoing (chemo)radiation with 3D-CRT or VMATDavid Paul Peschel0Mathias Düsberg1Jan C. Peeken2Jan Christian Kaiser3Kai Joachim Borm4Katharina Sommer5Stephanie E. Combs6Stefan Münch7Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM)Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM)Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM)Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU)Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM)Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM)Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM)Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM)Abstract The extent of elective nodal irradiation (ENI) in patients undergoing definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC) remains unclear. The aim of this dosimetric study was to evaluate the extent of incidental nodal irradiation using modern radiation techniques. A planning target volume (PTV) was generated for 30 patients with node-negative esophageal carcinoma (13 cervical/upper third, 7 middle third, 10 lower third/abdomen). Thereby, no elective nodal irradiation (ENI) was intended. Both three-dimensional conformal radiotherapy (3D-CRT) and volumetric-modulated arc therapy (VMAT) treatment plans (50 Gy in 25 fractions) were calculated for all patients. Fifteen nodal stations were contoured according to the definitions of the AJCC and investigated in regard to dosimetric parameters. Compared to 3D-CRT, VMAT was associated with lower dose distribution to the organs at risk (lower Dmean, V20 and V30 for the lungs and lower Dmean and V30 for the heart). For both techniques, the median Dmean surpassed 40 Gy in 12 of 15 (80%) nodal stations. However, VMAT resulted in significantly lower Dmeans and equivalent uniform doses (EUD) compared to 3D-CRT for eight nodal stations (1L, 2L, 2R, 4L, 7, 8L, 10L, 15), while differences did not reach significance for seven nodal station (1R, 4R, 8U, 8M, 10R, 16). For dCRT of ESCC, the use of VMAT was associated with significantly lower median (incidental) doses to eight of 15 regional lymph node areas compared to 3D-CRT. However, given the small absolute differences, these differences probably do not impair (regional) tumor control rates.https://doi.org/10.1038/s41598-022-26641-w |
| spellingShingle | David Paul Peschel Mathias Düsberg Jan C. Peeken Jan Christian Kaiser Kai Joachim Borm Katharina Sommer Stephanie E. Combs Stefan Münch Incidental nodal irradiation in patients with esophageal cancer undergoing (chemo)radiation with 3D-CRT or VMAT Scientific Reports |
| title | Incidental nodal irradiation in patients with esophageal cancer undergoing (chemo)radiation with 3D-CRT or VMAT |
| title_full | Incidental nodal irradiation in patients with esophageal cancer undergoing (chemo)radiation with 3D-CRT or VMAT |
| title_fullStr | Incidental nodal irradiation in patients with esophageal cancer undergoing (chemo)radiation with 3D-CRT or VMAT |
| title_full_unstemmed | Incidental nodal irradiation in patients with esophageal cancer undergoing (chemo)radiation with 3D-CRT or VMAT |
| title_short | Incidental nodal irradiation in patients with esophageal cancer undergoing (chemo)radiation with 3D-CRT or VMAT |
| title_sort | incidental nodal irradiation in patients with esophageal cancer undergoing chemo radiation with 3d crt or vmat |
| url | https://doi.org/10.1038/s41598-022-26641-w |
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