Resumen de Hypofractionated volumetric modulated arc therapy (VMAT) for fragile patients with oesophageal cancer

Letizia Deantonio, Simona Cima, Stefano Leva, Antonella Richetti, Mariacarla Valli

• Purpose To evaluate the feasibility, safety, and dosimetric results of volumetric modulated arc therapy (VMAT) to deliver hypofractionated radiotherapy (RT) in oesophageal cancer patients, unfit for a multimodality curative strategy.

  Patients/methods From 2010 to 2017, 22 patients were treated with hypofractionated VMAT for palliative/symptomatic setting. The prescription dose was 40 Gy in 16 fractions (EQD2 41.7 Gy considering an α / β ratio of 10 Gy, and 44 Gy con- sidering an α / β ratio of 3 Gy).

  Results Eight patients (36%) were symptomatic for grade 3 baseline dysphagia. RT was generally well tolerated, and no patient interrupted the daily treatment. Acute toxicity was generally mild; no G3 acute toxicities were reported. At the end of treatment, 5 patients (22.7%) experienced a stable dysphagia and 14 (63.6%) an improvement of baseline dysphagia, while 3 patients (13.7%) reported a worsening of oesophagitis. At a mean follow-up of 8.7 months, 15 patients (79%) had a complete clinical recovery (G0–1) of the symptomatic moderate/severe dysphagia. At 3 months after the end of RT, seven patients (31.8%) achieved a partial or complete response. Two coplanar arcs were employed for VMAT delivery. Dosimetric results were consistent in terms of both target coverage and normal tissue sparing. Finally, 1-year progression-free and overall survival was 20% and 27.3%, respectively.

  Conclusions Hypofractionated VMAT was feasible, safe, and effective to deliver symptomatic radiation in locally advanced oesophageal cancer patients, non-suitable for a standard curative treatment.