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Hypofractionated volumetric modulated arc therapy (VMAT) for fragile patients with oesophageal cancer

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Abstract

Purpose

To evaluate the feasibility, safety, and dosimetric results of volumetric modulated arc therapy (VMAT) to deliver hypofractionated radiotherapy (RT) in oesophageal cancer patients, unfit for a multimodality curative strategy.

Patients/methods

From 2010 to 2017, 22 patients were treated with hypofractionated VMAT for palliative/symptomatic setting. The prescription dose was 40 Gy in 16 fractions (EQD2 41.7 Gy considering an α/β ratio of 10 Gy, and 44 Gy considering an α/β ratio of 3 Gy).

Results

Eight patients (36%) were symptomatic for grade 3 baseline dysphagia. RT was generally well tolerated, and no patient interrupted the daily treatment. Acute toxicity was generally mild; no G3 acute toxicities were reported. At the end of treatment, 5 patients (22.7%) experienced a stable dysphagia and 14 (63.6%) an improvement of baseline dysphagia, while 3 patients (13.7%) reported a worsening of oesophagitis. At a mean follow-up of 8.7 months, 15 patients (79%) had a complete clinical recovery (G0–1) of the symptomatic moderate/severe dysphagia. At 3 months after the end of RT, seven patients (31.8%) achieved a partial or complete response. Two coplanar arcs were employed for VMAT delivery. Dosimetric results were consistent in terms of both target coverage and normal tissue sparing. Finally, 1-year progression-free and overall survival was 20% and 27.3%, respectively.

Conclusions

Hypofractionated VMAT was feasible, safe, and effective to deliver symptomatic radiation in locally advanced oesophageal cancer patients, non-suitable for a standard curative treatment.

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Authors and Affiliations

  1. Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Via Ospedale, 6500, Bellinzona, Switzerland

    Letizia Deantonio, Simona Cima, Stefano Leva, Antonella Richetti & Mariacarla Valli

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  1. Letizia Deantonio
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  2. Simona Cima
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  3. Stefano Leva
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  4. Antonella Richetti
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  5. Mariacarla Valli
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Correspondence to Letizia Deantonio.

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Deantonio, L., Cima, S., Leva, S. et al. Hypofractionated volumetric modulated arc therapy (VMAT) for fragile patients with oesophageal cancer. Clin Transl Oncol 22, 1532–1538 (2020). https://doi.org/10.1007/s12094-020-02293-y

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