***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To evaluate the clinical efficacy and toxicity of simultaneous integrated boost intensity-modulated radiotherapy ( SIB-IMRT ) in patients with esophageal squamous cell carcinoma ( ESCC ) in Chinese population . PATIENTS AND METHODS Patients with ESCC , who received SIB-IMRT from September 2011 to January 2013 were retrospectively analyzed . The SIB-IMRT plans were design ed to deliver primary gross tumor volume at 60 - 64.4 Gy in 28 - 30 fractions , and planning target volume at 50.4 - 56 Gy in 28 - 30 fractions . Treatment-related toxicities were estimated based on Common Terminology Criteria for Adverse Events version 4.0 , and tumor response after the treatment was estimated according to Response Evaluation Criteria in Solid Tumors version 1.0 . Overall survival ( OS ) , locoregional progression-free survival ( LPFS ) , and progression-free survival ( PFS ) were estimated with Kaplan-Meier . RESULTS All patients completed definitive radiotherapy , 54 ( 78.3 % ) received combined chemotherapy , of which 31 ( 44.9 % ) were concurrent chemoradiotherapy and 23 ( 33.3 % ) were sequential chemotherapy .  The objective response rate is 82.6 % ( 56/69 ) , with complete response 11 ( 15.9 % ) , partial response 45 ( 65.2 % ) , stable disease 8 ( 11.6 % ) , and progressive disease 5 ( 7.2 % ) . The 1- , 2- and 3-year LPFS was 74.4 % , 57.8 % , and 55.6 % , respectively . The 1- , 2- and 3-year PFS was 62.3 % , 41.0 % , and 34.2 % , respectively , and the 1- , 2- , and 3-year OS was 73.8 % , 57.4 % , and 41.0 % , respectively , with a median OS of 27.1 months ( 4.5 - 54.9 m ) . For those who received concurrent chemotherapy , the 1- , 2- , and 3-year OS was 75.9 % , 69.0 % , and 55.2 % , respectively , better than those who had sequential chemotherapy or radiotherapy alone ( χ2 = 3.115 , P = 0.078 ) . Radiation esophagitis occurred in 63.8 % and 14.5 % with Grade 2 and 3 , respectively . No patients occurred ≥ Grade 3 radiation pneumonia . CONCLUSIONS It is safe and effective using SIB-IMRT technology to treat patients with ESCC . More prospect i ve clinical studies should be needed PURPOSE / OBJECTIVE ( S ) Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony l and marks , and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy ( IMRT ) . Therefore , we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume ( CTV ) in esophageal or gastroesophageal junction ( GEJ ) cancer . METHODS AND MATERIAL S Eight expert academically based gastrointestinal radiation oncologists participated . Three sample cases were chosen : a GEJ cancer , a distal esophageal cancer , and a mid-upper esophageal cancer .  Uniform computed tomographic ( CT ) simulation data sets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert , and the expert was instructed to generate gross tumor volume ( GTV ) and CTV contours for each case . All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours . The panel then refined these contours to generate the contouring atlas . RESULTS The κ statistics indicated substantial agreement between panelists for each of the 3 test cases . A consensus CTV atlas was generated for the 3 test cases , each representing common anatomic presentations of esophageal cancer . The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases . CONCLUSIONS This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas . This atlas will serve as a reference for IMRT contours for clinical practice and prospect i ve trial design . Subsequent patterns of failure analyses of clinical data sets using these guidelines may require modification in the future The optimized concurrent chemoradiotherapy has not been established for patients with advanced esophageal squamous cell carcinoma ( SCC ) . The aim of the present study was to evaluate the safety and efficacy of concurrent chemotherapy and selective lymph node ( SLN ) late course accelerated hyperfractionated ( LCAF ) intensity modulated radiotherapy ( IMRT ) for the patients with thoracic SCC . Twelve patients with T3 - 4N0 - 1M0 - 1a thoracic esophageal SCC were included . The total dose of SLN LCAF IMRT was 59.6 Gy/34 fractions in 5.4 weeks . The concurrent chemotherapy protocol was as following : cisplatin 10 mg/m(2 ) on days 1 - 5 and 22 - 26 , pemetrexed in escalating doses , from the base level of 500 mg/m(2 ) once every 21 days . The primary objectives were to determine the maximum tolerated dose ( MTD ) , recommended dose ( RD ) , and dose limiting toxicities ( DLTs ) . Secondary end point included determination of preliminary radiographic response rates . As a result , three patients were enrolled in dose level 1 with pemetrexed 500 mg/m(2 ) and nine patients in dose level 0 with 400 mg/m(2 ) , respectively . At dose level 1 , DLTs occurred in two of three patients . However , only two of nine patients in Level 0 developed DLTs . The complete response and partial response were observed in eight and four patients , respectively . Furthermore , no patient experienced cancer progression with a median follow-up of 9 months . In conclusion , the concurrent SLN LCAF IMRT and chemotherapy is feasible . The MTD of pemetrexed in this regimen was 500 mg/m(2 ) and RD was 400 mg/m(2 ) . Although toxicities were common , the protocol was safe , well tolerated , and achieved an encouraging outcome Cisplatin-based concurrent chemoradiotherapy for patients with unresectable , locally advanced esophageal squamous cell carcinoma ( ESCC ) is associated with significant toxicities that are often intolerable . Prognosis for this subgroup of patients remains poor , and new therapeutic approaches are urgently needed . We investigated the efficacy and safety  of paclitaxel combined with erlotinib and concurrent radiotherapy in patients with inoperable ESCC .  Erlotinib ( 150 mg ) was administered daily for 60 days beginning at the start of radiotherapy , and paclitaxel ( 45 mg/m² ) was administered weekly along with intensity modulated conformal radiotherapy ( 60 Gy in 30 fractions ) . The median follow-up time was 21 months . The associations between EGFR and VEGF expression and treatment outcome were evaluated . Among the 21 patients treated , the overall response rate ( CR + PR ) was 85.6 % . The median LPFS , PFS and OS were : 17.5 , 14.3 , and 22.9 months , respectively . Treatment-related grade 3 toxicities included esophagitis ( two patients ) and hypoleukemia ( one patient ) . Grade 4 pulmonary toxicity was observed in one patient . Patients expressing EGFR had longer PFS , while those expressing VEGF or with a history of smoking had worse outcomes . Weekly paclitaxel combined with erlotinib and concurrent radiotherapy shows promise as an effective , tolerated regimen for patients with inoperable ESCC Purpose Volumetric-modulated arc therapy ( VMAT ) achieves high conformity to the planned target volume ( PTV ) and good sparing of organs at risk ( OAR ) . This study compares dosimetric parameters and toxicity in esophageal cancer ( EC ) patients treated with VMAT and 3D conformal radiotherapy ( 3D-CRT ) . Material s and methods Between 2007 and 2014 , 17 SC patients received neoadjuvant chemoradiation ( CRT ) with VMAT .  Dose – volume histograms and toxicity were compared between these patients and 20 treated with 3D-CRT .  All patients were irradiated with a total dose of 45 Gy . All VMAT patients received simultaneous chemotherapy with cisplatin and 5‑fluorouracil ( 5-FU ) in treatment weeks 1 and 5 . Of 20 patients treated with 3D-CRT , 13 ( 65 % ) also received CRT with cisplatin and 5‑FU , whereas 6 patients ( 30 % ) received CRT with weekly oxaliplatin and cetuximab , and a continuous infusion of 5‑FU ( OE-7 ) . Results There were no differences in baseline characteristics between the treatment groups . For the lungs , VMAT was associated with a higher V5 ( median 90.1 % vs. 79.7 % ; p = 0.013 ) and V10 ( 68.2 % vs. 56.6 % ; p = 0.014 ) , but with a lower V30 ( median 6.6 % vs. 11.0 % ; p = 0.030 ) . Regarding heart parameters , VMAT was associated with a higher V5 ( median 100.0 % vs. 91.0 % ; p = 0.043 ) , V10 ( 92.0 % vs. 79.2 % ; p = 0.047 ) , and Dmax ( 47.5 Gy vs. 46.3 Gy ; p = 0.003 ) , but with a lower median dose ( 18.7 Gy vs. 30.0 Gy ; p = 0.026 ) and V30 ( 17.7 % vs. 50.4 % ; p = 0.015 ) . Complete resection was achieved in 16 VMAT and 19 3D-CRT patients . Due to systemic progression , 2 patients did not undergo surgery . The most frequent postoperative complication was anastomosis insufficiency , occurring in 1 VMAT ( 6.7 % ) and 5 3D-CRT patients ( 27.8 % ; p = 0.180 ) . Postoperative pneumonia was seen in 2 patients of each group ( p = 1.000 ) . There was no significant difference in 3‑year overall ( 65 % VMAT vs. 45 % 3D-CRT ; p = 0.493 ) or 3‑year progression-free survival ( 53 % VMAT vs. 35 % 3D-CRT ; p = 0.453 ) . Conclusion Although dosimetric differences in lung and heart exposure were observed , no clinical ly relevant impact was detected in either patient group . In a real-life patient cohort , VMAT enables reduction of lung and heart V30 compared to 3D-CRT , which may contribute to reduced toxicity . ZusammenfassungZielDie volumetrisch modulierte Rotationstherapie ( VMAT ) erreicht eine hohe Abdeckung des Planungszielvolumens mit guter Schonung der Risikoorgane . Verglichen wurden dosimetrische Parameter und Toxizität zwischen VMAT und 3D-konformaler Strahlentherapie ( 3D-CRT ) bei Patienten mit Ösophaguskarzinom . Material und Method enZwischen 2007 und 2014 erhielten 17 Patienten während der neoadjuvanten Radiochemotherapie eine  VMAT . Dosis-Volumen-Histogramme und Toxizität wurden mit 20 mit 3D-CRT beh and elten Patienten verglichen . Die Gesamtdosis aller Patienten betrug 45 Gy ( Tagesdosis 1,8 Gy ) . Die VMAT-Gruppe erhielt eine simultane Chemotherapie mit Cisplatin und 5‑Fluoruracil ( 5-FU ) in der 1 . und 5 . Woche . In der 3D-CRT-Gruppe bekamen 13 Patienten ( 65 % ) ebenfalls eine Chemotherapie mit Cisplatin und 5‑FU , 6 Patienten ( 30 % ) eine wöchentliche Chemotherapie mit Oxaliplatin und Cetuximab , sowie eine kontinuierliche Chemotherapie mit 5‑FU (OE-7).ErgebnisseHinsichtlich der Basischarakteristika zeigte sich kein Unterschied zwischen den Gruppen . Für die Lungen  war VMAT  mit einer höheren V5 ( Median 90,1 % vs. 79,7 % ; p = 0,013 ) und V10 ( 68,2 % vs. 56,6 % ; p = 0,014 ) , aber einer niedrigeren V30 assoziiert ( Median 6,6 % vs. 11,0 % ; p = 0,030 ) . Für das Herz  waren für VMAT V5 ( Median 100 % vs. 91 % ; p = 0,043 ) , V10 ( 92 % vs. 79,2 % , p = 0,047 ) und Dmax ( 47,5 Gy vs. 46,3 Gy ; p =  
    Output:
    
In conclusion , our institutional data and the literature consistently show a low incidence of symptomatic RP after radiochemotherapy in patients with esophageal cancer treated with  IMRT .