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Then, intensity-modulated radiation therapy (IMRT) was administered: a total dose of 70 Gy to the gross tumor volume (GTV), 66 Gy to involved cervical lymph nodes, 64 Gy to the prophylactic radiation area of the primary lesion, and 58 Gy to bilateral cervical fields (all levels).
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Opposing lateral facial-cervical fields were used in the 2D-CRT to cover the nasopharynx and upper cervical lymphatic drainage region, with one lower anterior cervical field to cover the lower cervical region.
For the lower neck, an anterior cervical field was used.
In some patients, an additional anterior cervical field with a laryngeal block was used to treat the lower neck.
The lower cervical nodes were treated with a matched low anterior cervical field using an isocentric technique to eliminate divergence into treatment fields.
Historically, two-dimensional radiotherapy mainly used a large lateral opposing faciocervical field and a lower anterior cervical field, which made it difficult to sufficiently protect adjacent normal tissues.
For stage N1 3 patients, the lower neck area received conventional anterior cervical field radiation with a midline shield to 50 Gy in daily fractions of 2 Gy.
If nodal clearance is so important, should a more aggressive operation or adding a cervical field become standard for locally advanced esophageal cancer?
For the remainder of the N0 and all N1-3 disease patients, an anterior cervical field was used for irradiation of the lower neck.
In the first phase, patients were irradiated by a 6-MV photon beam with a daily fraction of 1.8 or 2.0 Gy (5~6 fractions per week) via bilateral opposing faciocervical fields and one lower anterior cervical field.
The anterior cervical photon field delivered 66 Gy to the visible neck nodes plus a 2 mm margin, as well as 54 Gy to the clinically negative nodal regions.
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