Dosimetric analysis between Intensity Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Esophageal Cancer Treatment: a systematic review
Abstract
BACKGROUND: Radiotherapy is one of the main treatments of esophageal cancer. Intensity-modulated radiation therapy (IMRT) is an advanced type of radiotherapy and is rapidly used in many sites of cancer including esophageal cancer. Due to the benefit of IMRT which theoretically can reduce the dose to normal organ and increase dose to the target volume, this study will evaluate the benefit of fixed-gantry IMRT and Volumetric Modulated Arc Therapy (VMAT) for treating esophageal cancer comparing to three-dimensional conventional radiotherapy (3DCRT). OBJECTIVES: To compare dosimetric data , cost effectiveness and quality of life of patients with esophageal cancer treated with IMRT technique comparing to 3DCRT. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE lists of articles during January 1990 to December 2015. SELECTION CRITERIA: Randomised controlled trials and Quasi-randomized controlled trials comparing the effect of Fixedgantry IMRT or VMAT versus 3DCRT on treating patients with esophageal cancer. DATA COLLECTION AND ANALYSIS: Three reviewers independently evaluated the quality of the relevant trials and extracted the data from the included trials. MAIN RESULTS: Six trials contributed to this review. Fixed-gantry IMRT did not show either superior comformal index (CI) or heterogeneity index (HI) while VMAT had a statistically significant better CI but no different HI. As organ-at-risk comparison, fixed-gantry IMRT and VMATsignificantly decreased the volume of lung receiving at least 20 Gy (V20), mean lung dose (MLD), and VMAT significantly decreased spinal cord maximal dose. There was no study showed local control, distant metastasis, progression-free survival, disease-free survival, or overall survival. There was also no study reported the cost effectiveness or quality of life. These trials did not report adverse events. CONCLUSIONS: These trials suggested that VMAT had a better CI. Fixed-gantry IMRT and VMAT statistically significant reduced the V20 to lung, MLD while VMAT also reduced spinal cord maximal dose. There was no such evidence of any important clinical effects on acute or late radiotherapy adverse events, local control, distant metastasis, progression-free survival, disease-free survival, or overall survival. There was also no evidence of the effect on the cost effectiveness or quality of life. Further research is required to establish the clinical benefit of any therapy. An economic evaluation should be undertaken.
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บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของวารสารมะเร็งวิวัฒน์ ข้อความที่ปรากฏในบทความแต่ละเรื่องในวารสารวิชาการเล่มนี้เป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับ และบุคคลากรท่านอื่น ๆ ใน สมาคมฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใดๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเองแต่ผู้เดียว
