A technique to reduce skin toxicity in radiotherapy treatment planning for esophageal cancer

PURPOSE: To demonstrate a specific skin dose limiting technique in radiotherapy treatment planning for esophageal cancer and carry out a comparative analysis combining with clinical cases. MATERIAL AND METHODS: Thirty patients with cervical and upper thoracic esophageal carcinoma previously treated in our institution were selected. A treatment plan had been finished previously according to the planning parameters directives from physician and delivered for each patient. In this study, we copied the previously delivered plans in radiotherapy treatment planning system and converted a low dose level (usually 5Gy) to a skin dose limiting structure (SDLS), then we set the objective functions of the SDLS in the Pinnacle Inverse Planning module and re‐optimize the plans to reduce the skin doses. Finally, we compared the dose distribution and other parameters of target volume and organs at risk (OARs) between the old plans and the new plans. RESULTS: There was no significant difference in most of OARs sparing. However, for all plans, the maximum dose to the SDLS decreased from 6145.90 ± 416.96 cGy to 5562.09 ± 616.69 cGy with maximum difference of 1361.30 cGy (P < 0.05), the percentage volume of 40Gy received by the SDLS decreased from (10.20 ± 6.36)% to (5.46 ± 4084)% with maximum difference of 9.89% (P < 0.05). For the target volume, there was no significant difference in the average dose and maximum dose, the approximate minimum dose to the target volume decreased from 5711.28 ± 164.61 cGy to 5584.93 ± 157.70 cGy (P < 0.05), the conformal index and homogeneity index of the target volume were hardly changed. CONCLUSION: In radiotherapy treatment planning for esophageal cancer patients, the skin dose can be significantly reduced using the skin dose limiting technique, and the impact on the dose to target volume and OARs is little, this technique can be used in most radiotherapy treatment planning.