ESTRO 2024 - Abstract Book

S2208

Clinical - Upper GI

ESTRO 2024

Keywords: esophageal cancer, auto-planning, personalized

1842

Digital Poster

Definitive chemoradiation in esophageal cancer using VMAT technique: report on clinical outcomes

Madhurya Reddy, Krishna Sharan, Anshul Singh, Shirley Lewis, Umesh Velu, Jayashree N. P.

Kasturba Medical College, Manipal Academy of Higher Education, Department of Radiotherapy and Oncology, Manipal - 576104, India

Purpose/Objective:

Treatment using volumetric modulated arc therapy (VMAT) technique allows for better dose distribution with the ability to deliver higher doses to the tumor and lower doses to surrounding normal tissues, resulting in lessened toxicities. The objective is to report the disease outcomes in esophageal cancer following definitive chemoradiation (dCRT) using VMAT technique.

Material/Methods:

This study was single arm, single center, prospective and non-blinded. Patients treated with definitive chemoradiation (dCRT) for esophageal cancer between March 2021 and September 2022 were considered. Those eligible for the study based on clinical assessment and investigation reports were included. Patients were simulated for radiotherapy according to subsite and considered for chemotherapy based on performance status and blood investigation reports. Radiation doses ranged from 50.4Gy/28#/5.5 weeks to 70Gy/35#/7 weeks with some receiving simultaneous integrated boost (SIB) technique with 50.4Gy/28#/5.5 weeks with escalated dose of 63Gy/28#/5.5 weeks (depending on the subsite), with concurrent weekly chemotherapy using either intravenous (IV) Cisplatin 40mg/m 2 or IV Carboplatin AUC2 using the Calvert formula. VMAT planning was done on Monaco v5.1 (Elekta) using arcs ranging up to 360 0 with 6MV photon energy. Plans were then reviewed for planning target volume (PTV) coverage and organs-at-risk (OAR) doses. Set-up verification was done using cone beam CT (CBCT) on the first day of treatment and weekly thereafter. Patients were reviewed weekly and on an as-needed basis for evaluation of toxicities, weight loss and blood parameters. On completion of treatment, patients were kept on follow-up as per standard protocol. Toxicities were evaluated as per Radiation Therapy Oncology Group (RTOG) scales.

Results:

30 patients were treated, of which 20 (67%) were male. Median age was 59 years. Three patients (10%) received neoadjuvant chemotherapy (NACT) – one patient received four cycles of Paclitaxel + Carboplatin, two patients received three cycles of Docetaxel + Cisplatin + 5-Fluorouracil. Two of 30 patients (7%) had two lesions within the esophagus. 10 patients (33%) had a cervical esophageal lesion. 13 patients (43%) had a stage II disease at presentation. 16 patients (53%) had a moderately-differentiated squamous cell carcinoma. 18 of 30 (60%) were