VMAT for lower third /GE jonction esophageal adenocarcinoma

[Kroll2013]

What is the indication of IMRT in distal esophageal carcinoma?
What would be the priority : lower lung V5 or lower heart V30 and lung V20?
Which is more correlated to radiation pneumonitis V5 or V20?

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[OTN]

IMRT usually improves lung sparing c/w 3D CRT for distal esophageal ca, and sparing of bowel and liver with coverage of the celiac axis is usually better with IMRT as well. Heart sparing can also be improved.

I tend to look at both V20 and V5; I'm not sure we have good enough data to say one is "better" w/r/t XRT pneumonitis than the other. In reality, they're both strongly correlated with each other (obviously), so teasing out which is better would be very statistically challenging. You'll probably find different answers at different institutions. For distal esophageal ca usually heart sparing isn't too problematic in my experience.