Comparison of conformal and intensity-modulated techniques for simultaneous integrated boost radiotherapy of upper esophageal carcinoma

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Abstract
AIM: To compare intensity-modulated radiotherapy (IMRT) with conformal radiotherapy (CRT) by investigating the dose profiles of primary tumors, electively treated regions, and the doses to organs at risk. METHODS: CRT and IMRT plans were designed for five patients with upper esophageal carcinoma. For each patient, target volumes for primary lesions (67.2 Gy) and electively treated regions (50.4 Gy) were predefined. An experienced planner manually designed one CRT plan. Four IMRT plans were generated with the same dose-volume constraints, but with different beam arrangements. Indices including dose distributions, dose volume histograms (DVHs) and conformity index were compared. RESULTS: The plans with three intensity-modulated beams were discarded because the doses to spinal cord were lager than the tolerable dose 45Gy, and the dose on areas near the skin was up to 50Gy. When the number of intensity beams increased to five, IMRT plans were better than CRT plans in terms of the dose conformity and homogeneity of targets and the dose to OARs. The dose distributions changed little when the beam number increased from five to seven and nine. CONCLUSION: IMRT is superior to CRT for the treatment of upper esophageal carcinoma with simultaneous integrated boost (SIB). Five equispaced coplanar intensity-modulated beams can produce desirable dose distributions. The primary tumor can get higher equivalent dose by SIB technique. The SIB-IMRT technique shortens the total treatment time, and is an easier, more efficient, and perhaps a less error-prone way in delivering IMRT.

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