PD04.02. Outcome and Dosimetric Comparison Between Intensity-Modulated Radiotherapy and Three-Dimensional Radiotherapy for Thoracic Esophageal Cancer in Japanese Population

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ID: 326152
2026
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Abstract
Abstract Topic Esophageal Cancer: Oncology/Radiation Therapy Background Intensity-modulated radiotherapy (IMRT) enables the delivery of optimal doses to the target while reducing doses to normal organs. Compared to three-dimensional conformal radiotherapy (3D-CRT), it is expected to reduce adverse events and improve treatment outcomes. However, concerns about increased risk of radiation pneumonitis due to low-dose exposure have hindered the widespread adoption of IMRT for thoracic esophageal cancer (TEC) in Japan. Our institution has used IMRT for some thoracic esophageal cancers. The purpose of this study is to analyze the outcome and dose-volume histogram (DVH) of IMRT for TEC and to compare them to 3D-CRT. Methods We retrospectively review patients who underwent radiotherapy for TEC at our institution from January 2021 to November 2024. Loco-regional recurrence (LRR), progression-free survival (PFS), and overall survival (OS) were evaluated. Radiation pneumonitis, pleural effusion, and pericardial effusion were assessed using Common Terminology Criteria for Adverse Events version 5. DVH of lung (V5Gy, V10Gy, V20Gy, V30Gy, V40Gy mean lung dose; MLD) and heart (V30Gy, mean heart dose; MHD) were calculated and correlations between DVH and toxicities (grade 2 or higher) were assessed using Chi-squared test (VXGy; volume received X Gy). Results A total of 51 patients (31 were 3D-CRT, 20 were IMRT) were included. The 1-year LRR, PFS and OS in 3D-CRT group were 31%, 58%, and 76%, while 25%, 56%, and 76% in IMRT group. In IMRT group, lung V10-40Gy, heart V30Gy and MHD were significantly low. Radiation pneumonitis, pleural effusion, pericardial effusion (grade 2 or higher) were observed in 2, 3, 7 patients in 3D-CRT group, and in 2, 3, 2 patients in IMRT group. Patients with high lung V30Gy, V40Gy, and MLD showed higher incidence of pleural effusion, while patients with high heart V30Gy and MHD showed higher incidence of pericardial effusion. No dose-dependent relationship was observed for radiation pneumonitis. In multivariate analysis, stage III-IV (HR: 10.18), male (HR: 4.51), and MHD > 18 Gy (HR: 27.67) were independent poor prognostic factors for OS. Conclusion IMRT for thoracic esophageal cancer can be safely administered without increasing radiation pneumonitis. The use of IMRT enables reduction of cardiopulmonary doses and may be useful in reducing chronic cardiopulmonary complications.
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Authors Masahiro Inada, Kiyoshi Nakamatsu, Saori Imamura, Naoko Hamazawa, Takahiro Okamoto, Junki Fukuda, Takuya Uehara, Makoto Hosono, Yukinori Matuso
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.097
URL
https://doi.org/10.1093/dote/doag077.097
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