Radiation therapy for esophageal cancer poses significant challenges in protecting normal tissues due to the proximity of critical organs such as the spinal cord, heart, and lungs. This challenge is further compounded by the risk of radiation-induced complications, particularly radiation pneumonia, a well-recognized side effect of radiation therapy. Previous studies investigating factors associated with radiation pneumonia have focused on comparing treatment planning techniques to reduce dose exposure to normal tissues, including the lungs.

Key factors such as the mean lung dose(Dmean), V10Gy (%), and V20Gy (%)—indicators of the lung volume receiving 10 Gy and 20 Gy, respectively—have been shown to correlate with an increased incidence of radiation pneumonia, underscoring their importance in treatment planning.

In studies on treatment techniques for esophageal cancer, IMRT and VMAT have demonstrated superior sparing of organs at risk (OAR) compared to 3D CRT and have been shown to reduce low-dose exposure to the lungs. This study aims to evaluate the effectiveness of treatment plans using three VMAT techniques: Full Arc VMAT (fVMAT), Partial Arc VMAT (pVMAT), and Non-Coplanar VMAT (ncVMAT). By comparing dose distributions to the tumor and surrounding normal tissues, we seek to assess the clinical utility and benefits of each approach.