Dosimetric Evaluation of 4 Field Three-Dimensional Conformal Radiation Therapy and 7 Field Intensity Modulated Radiation Therapy in Esophageal Cancer Treated with Definitive Chemoradiation

The present study aimed to evaluate dosimetrically and correlate the lung and heart dose volume histogram (DVH) of the 4 field three-dimensional conformal radiotherapy (3DCRT) with 7 field intensity modulated radiotherapy (IMRT) in patients with oesophageal cancers.
This retrospective dosimetric study considered 20 oesophagus cancer patients treated with definitive chemoradiation with IMRT technique. In the 7 field IMRT technique, the first phase delivered a dose of 36Gy/18fr followed by 18Gy/9fr in two weeks in the second phase. In the 3DCRT technique, the first phase was planned with 4 field technique with two parallel opposed and two posterior oblique fields, followed by the 3 field technique in the second phase. The assessments of the techniques were performed using differential DVH analysis of the right and left lungs, heart, and the spinal cord. The values of the mean dose, V20 (volume receiving 20 Gy), and V30 (volume receiving 30 Gy) were assessed for any correlations.
The DVH of V20 in IMRT showed 5% less lung volume irradiation compared with the 3DCRT plans and over 20% less V30 for irradiated heart volume. The study demonstrated a statistical advantage of using 7 field IMRT over 4 field 3DCRT in reducing the mean percentage dose to both lungs, heart, and spinal cord.
7 field IMRT is superior to 4 field 3DCRT plans in significantly reducing the average percentage of irradiated volume of both the lung and heart in esophageal cancer radiation therapy.