Image-guided radiotherapy of esophageal cancer by helical tomotherapy: Acute toxicity and preliminary clinical outcome

Yi Jen Chen, Kemp H. Kernstine, Stephen Shibata, Dean Lim, David D. Smith, Martin Tang, An Liu, Richard D. Pezner, Jeffrey Y C Wong

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Helical tomotherapy is a novel intensity-modulated radiotherapy modality with a helical 360° radiation delivery system and CT imaging ability. The purpose of this report is to review our initial experiences and to assess the toxicity and efficacy of helical tomotherapy for esophageal cancer. Methods: Twenty patients with locally advanced esophageal cancer (T3-4 and/or N+ and/or M1a/b) were treated with helical tomotherapy. Radiotherapy included simultaneous 50 Gy to gross tumorous areas and 45 Gy to areas of suspected subclinical disease. All received combination chemotherapy. Ten patients underwent surgical resection after completion of chemoradiation. Ten patients were ineligible for surgery. Results: The treatment was well-tolerated. There were no treatment-related deaths or Grade 4 toxicity. Grade 3 toxicities were noted in 9 of 20 patients (45%). Down-staging was noted in 7 of 10 patients (70%) who underwent surgery. The median follow-up time was 24.5 months. Eight patients, including 3 with surgery and 5 without surgery, have died. The 1-year overall survival rates for the entire group, patients with and without surgical resection are 80.0%, 100.0% and 60.0% respectively (log-rank p = 0.244, surgery versus no surgery). Conclusions: The regimen of combined chemoradiation by helical tomotherapy for locally advanced esophageal cancer is well-tolerated. The toxicity profile compares favorably with that of protocols based on conventional approach and the preliminary indications of efficacy are encouraging.

Original languageEnglish (US)
Pages (from-to)11-16
Number of pages6
JournalJournal of Thoracic Disease
Issue number1
StatePublished - Dec 1 2009


  • Esophageal cancer
  • Helical tomotherapy
  • Image-guided radiotherapy
  • Radiotherapy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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