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EIGHT-YEAR OUTCOMES OF VMAT-DIBH RADIATION THERAPY IN THE MULTIDISCIPLINARY MANAGEMENT OF ESOPHAGEAL CANCER AT VINMEC TIMES CITY INTERNATIONAL HOSPITAL
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Abstract
Objective: To evaluate treatment response, survival outcomes, and toxicity of volumetric modulated arc therapy with deep inspiration breath-hold (VMAT-DIBH) in the radiotherapy of esophageal cancer at Vinmec Times City International Hospital. Methods: A prospective study of 57 patients diagnosed with esophageal cancer and treated with VMAT-DIBH between 2017 and 2025. Analyzed parameters included patient characteristics, treatment features, compliance, tolerance/toxicity, treatment response, survival outcomes, and prognostic factors. Results: The mean age was 63.2 years; all were male. Squamous cell carcinoma accounted for 96.5%, and 76.8% had locally advanced disease (stage III: 48.2%; stage IVa: 28.6%). 37 patients received preoperative chemoradiotherapy and 20 underwent definitive treatment; 96.5% completed the treatment plan. In the preoperative group, 86.4% underwent radical surgery, with an R0 resection rate of 96.9%, and 43.8% achieved pathologic complete response (pCR). Grade ≥3 treatment-related toxicities occurred in 56.1% of patients; grade 3 esophagitis was the most common severe non-hematologic toxicity (25.3%); grade 4 toxicities were observed in 14%, all hematologic. All late toxicities were mild (grade 1–2). After a median follow-up of 17.0 months, the 3-year overall survival (OS), progression-free survival (PFS), and locoregional progression-free survival (LRPFS) rates were 61.3%, 44.8%, and 54.0%, respectively. Prognostic analysis showed that in the definitive group, radiologic complete response predicted favorable PFS (p=0.029); in the preoperative group, tumor length <5 cm was associated with a higher pCR rate (p=0.033). Conclusion: VMAT-DIBH radiotherapy for locally advanced esophageal cancer demonstrated favorable treatment response with an acceptable toxicity profile. Larger cohorts and longer follow-up are required to further assess survival outcomes.
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Keywords
Esophageal cancer, radiation therapy, deep inspiration breath-hold (DIBH), volumetric modulated arc therapy (VMAT)
References
2. Mohamed A.A. và cộng sự. Dosimetric advantages for cardiac substructures in radiotherapy of esophageal cancer in deep-inspiration breath hold. Strahlenther Onkol, 2024, 200(7): 624–632.
3. Hoeppner J. và cộng sự. Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer. N Engl J Med, 2025, 392(4): 323–335.
4. So T.H. và cộng sự. Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell Carcinoma. Adv Radiat Oncol, 2020, 5(5): 880–888.
5. Mukherjee S. và cộng sự. NEOSCOPE: A randomised phase II study of induction chemotherapy followed by oxaliplatin/ capecitabine or carboplatin/paclitaxel based pre-operative chemoradiation for resectable oesophageal adenocarcinoma. Eur J Cancer, 2017, 74: 38–46.
6. Yang H. và cộng sự. Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial. J Clin Oncol, 2018, 36(27): 2796–2803.
7. Crosby T. và cộng sự. Chemoradiotherapy with or without cetuximab in patients with oesophageal cancer (SCOPE1): a multicentre, phase 2/3 randomised trial. Lancet Oncol, 2013, 14(7): 627–637.
8. Suntharalingam M. và cộng sự. Effect of the Addition of Cetuximab to Paclitaxel, Cisplatin, and Radiation Therapy for Patients With Esophageal Cancer: The NRG Oncology RTOG 0436 Phase 3 Randomized Clinical Trial. JAMA Oncol, 2017, 3(11): 1520–1528.