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Münch, S.* ; Oechsner, M.* ; Combs, S.E. ; Habermehl, D.

DVH- and NTCP-based dosimetric comparison of different longitudinal margins for VMAT-IMRT of esophageal cancer.


Radiat. Oncol. 12:128 (2017)
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Open Access Gold
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Purpose: To cover the microscopic tumor spread in squamous cell carcinoma of the esophagus (SCC), longitudinal margins of 3-4cm are used for radiotherapy (RT) protocols. However, smaller margins of 2-3cm might be reasonable when advanced diagnostic imaging is integrated into target volume delineation. Purpose of this study was to compare the dose distribution and deposition to the organs at risk (OAR) for different longitudinal margins using a DVH- and NTCP-based approach. Methods: Ten patients with SCC of the middle or lower third were retrospectively selected. Three planning target volumes (PTV) with longitudinal margins of 4cm, 3cm and 2cm and an axial margin of 1.5cm to the gross target volume (GTV) were defined for each patient. For each PTV two treatment plans with total doses of 41.4Gy (neoadjuvant treatment) and 50.4Gy (definite treatment) were calculated. Dose to the lungs, heart, myelon and liver were then evaluated and compared between different PTVs. Results: Whe n using a longitudinal margin of 3cm instead of 4cm, all dose parameters (Dmin, Dmean, Dmedian and V5-V35), except Dmax could be significantly reduced for the lungs. Regarding the heart, a significant reduction was seen for Dmean and V5, but not for Dmin, Dmax, Dmedian and V10-V35. When comparing a longitudinal margin of 4cm to a longitudinal margin of 2cm, a significant difference was calculated for Dmin, Dmean, Dmedian and V5-V35 of the lungs and for Dmax, Dmean and V5-V35 of the heart. Nevertheless, no difference was seen for median heart dose. An additional dose reduction for V10 of the heart was achieved for definite treatment plans when using a longitudinal margin of 3cm. The NTCP-based risk of pneumonitis was significantly reduced by a margin reduction to 2cm for neoadjuvant and definite treatment plans. Conclusion: Reduction of longitudinal margins from 4cm to 3cm can significantly reduce the dose to lungs and Dmean of the heart. Despite clinical benefit and oncologic outcome remain unclear, reduction of the longitudinal margins might provide the opportunity to reduce side effects of chemoradiation (CRT) for SCC in upcoming studies.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Dosimetric Effects ; Esophageal Cancer ; Longitudinal Margins ; Modern Radiation Techniques; Squamous-cell Carcinoma; Positron-emission-tomography; Involved-field Radiotherapy; Elective Nodal Irradiation; Phase-iii Trial; Computed-tomography; Gastroesophageal Junction; Esophagogastric Junction; Prognostic-significance; Radiation Pneumonitis
ISSN (print) / ISBN 1748-717X
e-ISSN 1748-717X
Quellenangaben Volume: 12, Issue: 1, Pages: , Article Number: 128 Supplement: ,
Publisher BioMed Central
Publishing Place London
Reviewing status Peer reviewed