BACKGROUND: Despite maximum therapy the prognosis of esophageal carcinoma still remains extremely poor. New treatment strategies including improved radiation therapy techniques promise better outcome by improving local control through precise dose delivery due to higher conformality. CASE REPORT: A 62-year-old patient with locally advanced carcinoma of the gastroesophageal junction underwent definitive radiochemotherapy with intensity-modulated radiation therapy (IMRT). On positioning control with the in-room CT, the distal esophagus, and hence the tumor, was found to be highly mobile exhibiting changes in position of up to 4 cm from fraction to fraction. RESULTS: IMRT plans were created for various positions establishing a plan library to choose from as appropriate. CT scans were performed prior to each treatment fraction to clarify esophagus position in order to choose the adequate treatment plan. CONCLUSION: Image guidance was crucial in this unusual case of esophageal carcinoma. Without the information from position control CTs, the tumor would have received only about half the prescribed dose due to variations in position. For this specific case, in-room CT scans are probably superior to kilo- or megavoltage CTs due to the higher soft-tissue contrast enabling detection of positioning variation of the organ and offering the possibility to use the CT for treatment planning.
BACKGROUND: Despite maximum therapy the prognosis of esophageal carcinoma still remains extremely poor. New treatment strategies including improved radiation therapy techniques promise better outcome by improving local control through precise dose delivery due to higher conformality. CASE REPORT: A 62-year-old patient with locally advanced carcinoma of the gastroesophageal junction underwent definitive radiochemotherapy with intensity-modulated radiation therapy (IMRT). On positioning control with the in-room CT, the distal esophagus, and hence the tumor, was found to be highly mobile exhibiting changes in position of up to 4 cm from fraction to fraction. RESULTS: IMRT plans were created for various positions establishing a plan library to choose from as appropriate. CT scans were performed prior to each treatment fraction to clarify esophagus position in order to choose the adequate treatment plan. CONCLUSION: Image guidance was crucial in this unusual case of esophageal carcinoma. Without the information from position control CTs, the tumor would have received only about half the prescribed dose due to variations in position. For this specific case, in-room CT scans are probably superior to kilo- or megavoltage CTs due to the higher soft-tissue contrast enabling detection of positioning variation of the organ and offering the possibility to use the CT for treatment planning.
Authors: Eric Good; Hakan Oral; Kristina Lemola; Jihn Han; Kamala Tamirisa; Petar Igic; Darryl Elmouchi; David Tschopp; Scott Reich; Aman Chugh; Frank Bogun; Frank Pelosi; Fred Morady Journal: J Am Coll Cardiol Date: 2005-11-09 Impact factor: 24.094
Authors: Hans Kottkamp; Christopher Piorkowski; Hildegard Tanner; Richard Kobza; Anja Dorszewski; Petra Schirdewahn; Jin-Hong Gerds-Li; Gerhard Hindricks Journal: J Cardiovasc Electrophysiol Date: 2005-02
Authors: Gerold Mönnig; Johannes Wessling; Kai U Juergens; Peter Milberg; Michael Ribbing; Roman Fischbach; Johannes Wiekowski; Günter Breithardt; Lars Eckardt Journal: Europace Date: 2005-11 Impact factor: 5.214
Authors: Zhen Zhang; Zhongxing Liao; Jing Jin; Jaffer Ajani; Joe Y Chang; Melenda Jeter; Thomas Guerrero; Craig W Stevens; Stephen Swisher; Linus Ho; James Yao; Pamela Allen; James D Cox; Ritsuko Komaki Journal: Int J Radiat Oncol Biol Phys Date: 2005-03-01 Impact factor: 7.038
Authors: Tilman Bostel; Nils H Nicolay; Jörg G Grossmann; Angela Mohr; Stefan Delorme; Gernot Echner; Peter Häring; Jürgen Debus; Florian Sterzing Journal: Radiat Oncol Date: 2014-01-09 Impact factor: 3.481