Dosimetric Comparison between Intensity Modulated Radiation Therapy (IMRT) and Three-Dimensional Conformal Radiation Therapy (3DCRT) in Mid Lower esophageal Carcinoma: An Analytical Observational Study

Tavseef Ahmad Tali, Fiza Amin, Aijaz Ahmad Khan, Shahid Rashid Sofi, Mushtaq Ahmad Sofi, Mohsin Rehman Khan


Esophageal cancer (EC) is a common cancer with high mortality because of its rapid progression and poor prognosis. One of the most successful therapies for EC is radiotherapy. Two recently created radiation methods are intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT). In terms of target coverage, dose homogeneity, and lowering toxicity to healthy organs, IMRT is thought to be superior to 3D-CRT. These benefits haven't been proven in the treatment of EC, though. This study was performed to investigate if intensity modulated radiation therapy (IMRT) offers a better planning target volume (PTV) coverage and/or lower dose to organs at risk in comparison to three-dimensional conformal radiation therapy (3DCRT). 30 patients with locally advanced histo-pathologically proven mid and lower oesophageal carcinoma, not reaching gastro-esophageal junction were treated with chemoradiation using IMRT technique. 3DCRT plans were generated for those 30 patients. The IMRT and 3DCRT plans were compared in terms of PTV coverage and doses to organs at risk. Our results revealed that IMRT is better than 3DCRT comparing PTV coverage and doses to organs at risk having statistically significant difference between both techniques (p<0.001). As for the organs at risk (OAR), the V20 for the IMRT plans delivered lesser lung volume irradiation also the mean dose to the heart and the V30 were both higher in the 3DCRT plans.

Keywords: esophageal cancers (ECs), Organs at risk (OAR), Intensity modulated radiation therapy (IMRT), Three-dimensional conformal radiation therapy (3DCRT), Planned target volume (PTV).

Full Text:



Al-Sarraf, M., Martz, K., Herskovic, A., Leichman, L., Brindle, J.S., Vaitkevicius, V.K., et al., 1997, Progress Report of Combined Chemoradiotherapy versus Radiotherapy Alone in Patients with Esophageal Cancer: An Intergroup Study, Journal of Clinical Oncology, 15(1) ,277-284. CrossRef

Bosset, J., Gignoux, M., Triboulet, J.P., Tiret, E., Mantion, G., Elias, D., et al., 1997, Chemoradiotherapy Followed by Surgery Compared with Surgery Alone in Squamous Cell Cancer of the Esophagus, The New England Journal of Medicine, 337(3), 161-167. CrossRef

Chandra, A., Guerrero, T.M., Liu, H.H., Tucker, S.L., Liao, Z., Wang, X., et al., 2005, Feasibility of using intensity-modulated radiotherapy to improve lung sparing in treatment planning for distal esophageal cancer, Radiother Oncol, 77(3), 247–253. CrossRef

Chen, Y-J., Liu, A., Han, C., Tsai, P.T., Schultheiss, T.E., Pezner, R.D., et al., 2007, Helical Tomotherapy for Radiotherapy in Esophageal Cancer: A Preferred Plan with Better Conformal Target Coverage and More Homogeneous Dose Distribution, Medical Dosimetry, 32(3), 166-171. CrossRef

Domper Arnal, M.J., Ferrandez Arenas A., and Lanas Arbeloa A., 2015, Esophageal cancer: risk factors, screening and endoscopic treatment in Western and Eastern countries, World J Gastroenterol, 21, 7933–43. CrossRef

Fenkell, L., Kaminsky, I., Breen, S., Huang, S., Van Prooijen, M., and Ringash, J., 2008, Dosimetric Comparison of IMRT vs. 3D Conformal Radiotherapy in the Treatment of Cancer of the Cervical Esophagus, Radiotherapy and Oncology, 89(3), 287-291. CrossRef

Ghosh, S., Kapoor, R., Gupta, R., Khosla, D., Kochhar, R., Oinam, A.S., Sharma, R., and Sharma, S.C., 2012, An Evaluation of Three-Dimensional Conformal Radiation Therapy versus Intensity Modulated Radiation Therapy in Radical Chemoradiation of Esophageal Cancer: A Dosimetric Study, Clinical Cancer Investigation Journal, 1(2), 65-70. Link

Hu, X., He, W., Wen, S., Feng, X., Fu, X., Liu, Y., and Pu, K., 2016, Is IMRT superior or inferior to 3DCRT in radiotherapy for NSCLC? A meta-analysis, PLoS One, 11(4), e0151988. CrossRef

Jemal, A., Siegel, R., Ward, E., Hao, Y., Xu, J., Murray, T., and Thun, M.J., 2008, Cancer Statistic, CA: A Cancer Journal for Clinicians, 58(2), 71-96. CrossRef

Kole, T.P., Aghayere, O., Kwah, J., Yorke, E.D., and Goodman, K.A., 2012, Comparison of heart and coronary artery doses associated with intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for distal esophageal cancer, Int J Radiat Oncol Biol Phys, 83(5), 1580–1586. CrossRef

Liang, H., Fan, J.H., and Qiao, Y.L., 2017, Epidemiology, etiology, and prevention of esophageal squamous cell carcinoma in China, Cancer Biol Med, 14(1), 33–41. CrossRef

Ling, T.C., Slater, J.M., Nookala, P., Mifflin, R., Grove, R., Ly, A.M., et al., 2014, Analysis of intensity-modulated radiation therapy (IMRT), proton and 3D conformal radiotherapy (3D-CRT) for reducing perioperative cardiopulmonary complications in esophageal cancer patients, Cancers, 6(4), 2356–2368. CrossRef

Nutting, C., Dearnalay, D.P., and Webb, S., 2000, Intensity Modulated Radiation Therapy: A Clinical Review, The British Journal of Radiology, 73(869), 459-469. CrossRef

Nutting, C.M., Bedford, J.L., Cosgrove, V.P., Tait, D.M., Dearnaley, D.P., and Webb, S., 2001, A Comparison of Conformal and Intensity-Modulated Techniques for Oesophageal Radiotherapy, Radiotherapy and Oncology, 61(2), 157-163. CrossRef

Pennathur, A., Gibson, M.K., Jobe, B.A., and Luketich, J.D., 2013, Oesophageal carcinoma, Lancet, 381(9864), 400–412. CrossRef

Vivekanandan, N., Sriram, P., Kumar, S.A.S., Bhuvaneswari, N., and Saranya, K., 2012, Volumetric Modulated Arc Radiotherapy for Esophageal Cancer, Medical Dosimetry, 37(1), 108-113. CrossRef

Wang, D., Yang, Y., Zhu, J., Li, B., Chen, J., and Yin, Y., 2011, 3D-conformal RT, fixed-field IMRT and RapidArc, which one is better for esophageal carcinoma treated with elective nodal irradiation, Technol Cancer Res Treat, 10(5), 487–494. CrossRef

Wu, Z., Xie, C., Hu, M., Han, C., Yi, J., Zhou, Y., et al., 2014, Dosimetric Benefits of IMRT and VMAT in the Treatment of Middle Thoracic Esophageal Cancer: Is the Conformal Radiotherapy Still an Alternative Option?, Journal of Applied Clinical Medical Physics, 15(3), 93-101. CrossRef

Yang, B., Zhu, L., Cheng, H., Li, Q., Zhang, Y., and Zhao, Y., 2012, Dosimetric comparison of intensity modulated radiotherapy and three-dimensional conformal radiotherapy in patients with gynecologic malignancies: a systematic review and meta-analysis, Radiat Oncol, 7, 197. CrossRef


Copyright (c) 2022 Tavseef Ahmad Tali, Fiza Amin, Aijaz Ahmad Khan, Shahid Rashid Sofi, Mushtaq Ahmad Sofi, Mohsin Rehman Khan

Indexed by:




Indonesian Society for Cancer Chemoprevention