Carcinoma of the esophagus is among the most rapidly increasing cancers in incidence. With the use of aggressive bimodality and trimodality treatment strategies, the reduction of treatment toxicity is of prime importance [1]. Radiotherapy plays a key role in definitive, adjuvant and neoadjuvant treatment for carcinoma of the esophagus. Due to extensive vascular and lymphatic drainage, and therefore tendency to present at an advanced stage, the volumes required to adequately cover gross disease are substantial. Other critical organs in close proximity are therefore at risk for radiotherapy-induced toxicity, including the lung parenchyma, heart, spinal cord, stomach and others. Conventional 3D conformal radiotherapy techniques (3 field or 4 field) have traditionally been used at our center to provide adequate coverage to the target volume of the esophageal tumor and lymph nodes; however as a consequence doses delivered to these Organs At Risk (OARs) may be high. Intensity Modulated Radiotherapy (IMRT) and Volumetric Arc Radiotherapy (VMAT) has also been considered in the past, however comparisons of these plans have shown variable results in normal tissue sparing. Furthermore these techniques may impart a higher volume of low dose radiotherapy to substantial amounts of normal tissue. We compared conventional 3D CRT plans with IMRT or VMAT plans for a series of esophageal cancer patients with tumors of varying location at our center to determine the optimal treatment planning strategy.

Background: The factors affecting survival were evaluated in patients aged ≥ 70 years with Non-Small Cell Lung Cancer (NSCLC) treated with definitive Radiotherapy (RT).

Methods: Between January 1996 and April 2012, 52 patients were treated. The median age was 73 (range 70-80) and 73% and 75% of patients with stage III according to AJCC 2002 and AJCC 2010 staging, respectively. Radiotherapy was performed median 6160 cGy (range: 3600-6660 cGy) and CHE were given 75% of the patients.

Results: Median follow-up was 12.5 (range: 2.5-103) months. Median overall (OS) and Disease-Free (DFS) Survival were 22 and 18.5 months, respectively. Radiotherapy related death was not observed. In Univariate analysis; AJCC 2002 stage I-II, RT dose, RT duration, for OS and RT dose, RT duration, neoadjuvant CHE ≤ 3 cycles, complete response, ≥ 4 cycles of CHE for DFS were significant (p <0.05). In multivariate analysis, RT duration > 49 days related with higher RT dose (≥ 60 Gy) were found a positive impact on OS (HR: 3.235, 95% CI: 1:25 to 8:32 p = 0.01).

Conclusion: In our study, elderly patients with NCSLC can be given ≥ 60 Gy without complications and was seen positively impact on survival.