Intensity-modulated radiation therapy with concurrent chemotherapy for locally advanced cervical and upper thoracic esophageal cancer

Table 1 Patient and treatment characteristics for the 7 patients with cervical and upper thoracic esophageal cancer

PatientNo.	Tumordistancefrom UES (cm)	Stage	Inductionchemotherapy	Concurrentchemotherapy	XRT dose(GTV)	XRT dose(CTV)	XRT dose(supraclavical regions)
1	2	T3N1M0		5-FU, CDDP	64.8 Gy (2.31 Gy/f)	50.4 Gy (1.8 Gy/f)	50.4 Gy (1.8 Gy/f)
2	0	T2N1M0		5-FU, paclitaxel	59.9 Gy, (2.14 Gy/f)	50.4 Gy (1.8 Gy/f)	0
3	0	T3N1M0		5-FU, CDDP	64.8 Gy (1.8 Gy/f × 8, 2.21 Gy × 21)	51.7 Gy (1.53 Gy/f × 8, 1.88 Gy × 21)	46 Gy (1.36 Gy/f × 8, 1.67 Gy × 21)
4	6	T3N0M0		5-FU, paclitaxel	59.4 Gy (1.8 Gy/f)	59.4 Gy (1.8 Gy/f)	0
5	0	T4N1M0		5-FU, CBP, docetaxel	66 Gy (2.0 Gy/f)	66 Gy (2.0 Gy/f)	0
6	2.5	T4N1M0	CBP, paclitaxel	CBP, paclitaxel	66 Gy (2.0 Gy/f)	56 Gy (1.7 Gy/f)	56 Gy (1.7 Gy/f)
7	0	T4N0M0		5-FU, CDDP	66 Gy (2.0 Gy/f)	60 Gy (1.8 Gy/f)	60 Gy (1.8 Gy/f)

CBP: Carboplatin; CDDP: Cisplatin; CTV: Clinical tumor volume; GTV: Gross tumor volume; f: Fraction; UES: Upper esophageal sphincter; XRT: Radiotherapy

Table 2 Beam arrangement of IMRT plans for the 7 patients with cervical and upper thoracic esophageal cancer

Number of beams	Gantry angles	Number of segments	Number of monitor units per fraction	Total fraction	Total monitorunits
7	0, 25, 65, 141, 212, 295, 335	315	1395	28	39 060
5	40, 70, 220, 240, 290	218	759	28	21 252
9	0, 18, 35, 70, 150, 225, 295, 320, 340	559	1248 and 1468	8 + 21	40 812
7	0, 30, 60, 105, 260, 300, 330	270	749	33	24 717
5	0, 50, 120, 240, 300	198	831	33	27 423
8	12, 36, 60, 135, 225, 300, 324, 348	332	1288	33	42 504
9	0, 40, 70, 130, 160, 200, 230, 290, 320	417	972	33	32 076

Table 3 Dosimetric results of IMRT for 7 patients with cervical and upper thoracic esophageal cancer

Patient No.	Dose (Gy)	GTV volume(cm3)	PTV meandose (Gy)	PTV min%	PTV max%	PTV SD%	Lung V20(Gy)	Lung meandose (Gy)	Spinal cordmax (Gy)
1	64.8 (GTV)	58	70.5	96.5	117.9	4.9	18.9	12.0	42.8
	50.4 (CTV)		66.4	104.8	149.6	11.1
	50.4 (sup)		61.3	101.6	149.2	11.9
2	59.9 (GTV)	53	65.0	91.2	122.9	6.0	28.6	13.4	25.7
	50.4 (CTV)		58.7	103.9	139.4	6.6
3	64.8 (GTV)	85	68.6	97.8	117.5	3.7	10.3	6.6	37.2
	51.7 (CTV)		62.3	93.8	121.2	9.2
	46 (sup)		54.2	100	143	8.1
4	59.4 (GTV)	17	65.0	97.1	119.1	4.3	24.2	11.6	39.2
5	66 (GTV)	78	67.3	97.9	109.2	4.9	26.8	12.6	45.8
6	66 (GTV)	229	68.0	98.2	110.9	4.8	21.9	7.7	40.2
	56 (CTV + neck)		59.8	101.1	122.9	9.4
7	66 (GTC)	169	66.4	99.4	111.8	5.7	36	17.6	41.8
	60 (CTV)		65.7	97	121.6	6.7
	60 (sup)		67.1	105	116.8	5.4

GTV: Gross tumor volume; CTV: Clinical target volume; PTV: Planning target volume; sup: Bilateral supraclavicular region; min: Minimum; max: Maximum; SD: Standard deviation.

Table 4 Treatment response and toxicities for the 7 patients with cervical and upper thoracic esophageal cancer

Patient No.	Response (primary and node)	Relapse	Life status	Leucopenia (grade)	Dermatitis (grade)	Esophagitis (grade)	Pneumonitis(grade)	Late esophageal toxicity (grade)
1	CR	LR	DOD	1	1	2	0	0
2	Not evaluable	Not evaluable	DOD	1	3	2	0	not evaluable
3	CR	NED	Alive NED	0	1	2	0	0
4	CR	LR	Alive NED	3	1	1	0	3
5	CR	NED	Alive NED	0	3	1	0	3
6	CR	DM and node	DOD	0	3	2	0	0
7	CR	DM	Alive with disease	4	2	4	0	4

LR: Local recurrence in the esophagus; NED: No evidence of disease; DM: Distant metastasis; DOD: Died of disease