IMRT limits nephrotoxicity after chemoradiotherapy for gastric cancer

Trip, Anouk Kirsten; Nijkamp, Jasper; Tinteren, Harm van; Cats, Annemieke; Boot, H.; Jansen, Edwin P.M.; Verheij, Marcel

doi:10.1016/j.radonc.2014.08.039

Cited by 30 publications

(11 citation statements)

References 27 publications

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“…IMRT allows physicians to target the tumor while sparing nearby organs at risk, simultaneously reducing toxicity as well as improving coverage of the target volume. Previous studies have exhibited IMRT to be feasible in treating gastric cancer [39, 40], and in fact have also demonstrated a reduction in toxicity with this approach [41]. However, the use of IMRT for a moving target is yet another obstacle.…”

Section: Discussionmentioning

confidence: 99%

Hitting a Moving Target: Successful Management of Diffuse Large B-cell Lymphoma Involving the Mesentery With Volumetric Image-guided Intensity Modulated Radiation Therapy

Yoder

Gunther

Milgrom

et al. 2019

Clinical Lymphoma Myeloma and Leukemia

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Introduction: We report successful treatment of mesenteric diffuse large B-cell lymphoma (DLBCL) using localized involved site radiation therapy (ISRT), intensity modulated radiation therapy (IMRT), and daily CT-image guidance. Methods: Patients with mesenteric DLBCL treated with RT between 2011 and 2017 were reviewed. Clinical and treatment characteristics were analyzed for an association with local control (LC), progression free survival (PFS) and overall survival (OS). Results: Twenty-three patients were eligible. At diagnosis, the median age was 52 years (38–76), and 57% (n=13) had stage I/II DLBCL. All patients received frontline chemotherapy (ChT) (R-CHOP, n=19; dose-adjusted R-EPOCH, n=4) with median 6 cycles. Prior to RT, salvage ChT for refractory DLBCL was given to 43% (n=10) and autologous stem cell transplantation was administered in 13% (n=3). At the time of RT, PET-CT revealed five-point scale (5PS) of 1–3 (48%, n=11), 4 (9%, n=2), and 5 (44%, n=10). All patients received IMRT, daily CT imaging and ISRT. The median RT dose was 40 Gy (16.2–49.4). Relapse or progression occurred in 22% (n=5). At median follow-up of 37 months, the 3-year LC, PFS and OS rates were 80%, 75% and 96%, respectively. Among patients treated with RT after complete metabolic response to frontline ChT (n=8), 3-year PFS was 100%, compared to 61% for patients with history of chemorefractory DLBCL (n=15, p=0.055). Four of the five relapses occurred in patients with 5PS of 5 prior to RT (p=0.127). Conclusion: Mesenteric involvement of DLBCL can be successfully targeted with localized ISRT fields using IMRT and daily CT-image guidance.

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Section: Discussionmentioning

confidence: 99%

Hitting a Moving Target: Successful Management of Diffuse Large B-cell Lymphoma Involving the Mesentery With Volumetric Image-guided Intensity Modulated Radiation Therapy

Yoder

Gunther

Milgrom

et al. 2019

Clinical Lymphoma Myeloma and Leukemia

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“…For 90% of the patients, the two radiation oncologists who were asked to blindly designate the most appropriate plan from the dose-volume histograms (DVH) chose an IMRT treatment plan because of better coverage of the target volume while better sparing organs at risk. Subsequently, many dosimetric studies had compared 3D-CRT treatment plans with IMRT treatment plans, showing a reduction in the dose received by the organs at risk [16] , [45] . One retrospective study reported a decrease in the dose received by the liver and kidneys by comparing the treatments received by 57 patients.…”

Section: Proposalmentioning

confidence: 99%

Adjuvant chemoradiation for gastric carcinoma: State of the art and perspectives

Schernberg

Campo

Rousseau³

et al. 2018

Clinical and Translational Radiation Oncology

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“…One study 41 retrospectively analysed patients with gastric cancer treated with AP-PA, 3D-conformal, and IMRT techniques and found a robust lower dose to the left kidney with IMRT than with the AP-PA and 3D-conformal techniques. As a result, nephrotoxicity was less severe with IMRT than with the other methods.…”

Section: Intensity-modulated Radiotherapymentioning

confidence: 99%

Chemoradiation for gastric cancer: controversies, updates and novel techniques

Fan

Zhang

2015

BJR

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The INT0116 trial established the role of adjuvant chemoradiation (CRT) in the multidisciplinary approach to the management of locally advanced gastric cancer. However, whether adjuvant CRT is indispensable for patients undergoing D2 dissection remains undefined. The adjuvant chemoradiation therapy in stomach cancer (ARTIST) trial, which was designed to compare adjuvant chemotherapy to CRT, failed to demonstrate differences in disease-free and overall survival in the whole study group; however, subgroup analysis indicated that patients with lymph node metastasis may benefit from additional radiation. A follow-up ARTIST II trial is currently under way. The efficacy of adjuvant CRT remains controversial because of variation among studies in the inclusion criteria and treatment delivery methods; however, the identification of patients who would benefit from CRT is critical. Advanced radiotherapy techniques such as intensity-modulated radiotherapy protect normal tissues via motion management and decreased radiation-induced toxicity and contribute to plan optimization. Further studies integrating clinical and molecular factors as well as neoadjuvant CRT are warranted.Gastric cancer is one of the most frequent malignancies. It is the fifth most common malignancy and the third leading cause of cancer-related death in the world.

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IMRT limits nephrotoxicity after chemoradiotherapy for gastric cancer

Cited by 30 publications

References 27 publications

Hitting a Moving Target: Successful Management of Diffuse Large B-cell Lymphoma Involving the Mesentery With Volumetric Image-guided Intensity Modulated Radiation Therapy

Hitting a Moving Target: Successful Management of Diffuse Large B-cell Lymphoma Involving the Mesentery With Volumetric Image-guided Intensity Modulated Radiation Therapy

Adjuvant chemoradiation for gastric carcinoma: State of the art and perspectives

Chemoradiation for gastric cancer: controversies, updates and novel techniques

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