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Radiopharmaceutical-Guided Personalized Adjuvant Radiotherapy Planning after Esophageal Cancer Resection
Zhida Fu1, Yinghui Fang2, Dapeng Wang3
1Aviation General Hospital (Thoracic Surgery), Chaoyang, Beijing, China.
Background:
Esophageal cancer often has a significant locoregional recurrence risk after curative resection. Conventional postoperative radiation is largely based on anatomical imaging, which may not adequately detect microscopic residual disease or biological tumor heterogeneity.
Purpose/Hypothesis:
The incorporation of radiopharmaceutical-guided molecular imaging enables biologically adaptive dosage adjustment.
Population/Subjects:
The study assesses the feasibility and therapeutic efficiency of radionuclide-informed individualized adjuvant radiation planning following esophageal cancer resection.
Assessment:
Positron Emission Tomography (PET)/Computed Tomography (CT) imaging with tumor-specific tracers enabled the identification of biological targets.
Statistical Tests:
Voxel-based dose painting was used, and plans were compared using the conformity index (CI), homogeneity index, V95% coverage, tumor control probability (TCP), and normal tissue complication probability (NTCP). Radiopharmaceutical imaging revealed additional high-risk areas in 34.7% of patients. Personalized planning increased the CI (1.21 to 0.97), V95% (91.2% to 97.8%), and TCP (68.4% to 82.9%). Mean lung and heart doses decreased by 14.3% and 11.7%, respectively, decreasing the predicted NTCP for pneumonitis from 16.5% to 9.2% (p < 0.001).
Results:
Radionuclide-guided personalized adjuvant radiation improves biological target coverage, increases TCP, and minimizes normal tissue toxicity, hence confirming its role in precision postoperative management of esophageal cancer.
