Intensity-modulated radiation therapy in the treatment of gastric cancer: early clinical outcome and dosimetric comparison with conventional techniques

Milano, Michael T.; Garofalo, Michael; Chmura, Steven J.; Farrey, Karl; Rash, Carla; Heimann, Ruth; Jani, Ashesh B.

doi:10.1259/bjr/43441736

Cited by 84 publications

(102 citation statements)

References 18 publications

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“…All patients were treated in the clinical ward of the radiation oncology department, with strict clinical control and observation, and there were no interruptions to therapy, except in three cases with an IMRT delay of 2-3 days. Thus, therapy was more continuous than is usually achieved with con RT [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…The standard target dose of 45 Gy far exceeds the tolerance of several surrounding, critical normal tissues (most notably the kidneys and liver). As a result, con RT volumes are often significantly influenced by the need to avoid potential kidney and liver damage, but the resulting underdosing of some parts of the target can compromise local control and survival [8].…”

Section: Introductionmentioning

confidence: 99%

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Image-guided intensity-modulated radiotherapy for patients with locally advanced gastric cancer: a clinical feasibility study

et al. 2013

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Background The aim of this study was to determine the medical and technical feasibility of intensity-modulated radiotherapy (IMRT) in high-risk nonmetastatic gastric cancer stage II and III after primary gastrectomy and D2 lymphadenectomy. Methods and materials A prospective nonrandomized phase II trial was performed on 25 consecutive patients with gastric cancer with high risk (T3-4, N1-3, G2-3, R0-1). The dose delivered was 45 Gy (1.80 Gy per fraction) in IMRT technique. Concurrent 5-fluorouracil-based chemotherapy at 225 mg/m 2 was administered as a continuous intravenous infusion. Primary endpoints were acute gastrointestinal toxicity (CTC 4.0) and technical feasibility of IMRT in regard to dose planning and radiation delivery. Results Early acute events were defined as clinical and chemical adverse effects of IMRT and concurrent chemotherapy during treatment. By definition, 90 days after the end of IMRT has been evaluated as acute-phase toxicity. No patient had grade 4 or higher acute adverse events. Clinical grade 3 toxicity occurred in two patients (8 %) with diarrhea and in one case (4 %) with nausea. Hematological changes with grade 3 occurred in three cases (12 %) with hemoglobin decrease, in five cases (25 %) as leukopenia, and in one case (4 %) with thrombocytopenia. The mean dose for liver was 16 Gy and the percentage volume exceeding 30 Gy (V30) was 21 %. Mean dose for right and left kidney was 9 and 13 Gy, respectively, and V20 was 9 % and 13 %, respectively. Heart received a median dose of 15 Gy and V40 was 17 %. The mean dose to the bowel was 11 Gy and V40 was 6 %. Spinal cord had at maximum 33 Gy in median. Specifics of dose distribution, including the coverage, for the target region were as follows: minimum was 33 Gy, maximum 48.6 Gy, and mean dose 44.6 Gy. The prescribed dose (45 Gy) covered 99 % and 95 % of planning target volume (OTV) in 66 % and 92 % of cases, respectively. Median PTV was 15.77 ml (range, 805-3,604 ml). Conclusions The data support the practical feasibility of IMRT in adjuvant treatment in high-risk gastric cancer in the postoperative setting as a proof of principle. Acute toxicity has been tolerable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Image-guided intensity-modulated radiotherapy for patients with locally advanced gastric cancer: a clinical feasibility study

et al. 2013

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“…IMRT and image-guided radiotherapy (IGRT) have been demonstrated to be feasible approaches for delivering chemoradiation with improved dose coverage to the target volumes, and further sparing of organs at risk [28][29][30][31]. In our center, IGRT with respiratory control (either by gating or breath-hold) has been implemented routinely since 2008, aiming to reduce the effect of organ motion.…”

Section: Secondary Malignancymentioning

confidence: 99%

Adjuvant chemoradiation for resected gastric cancer: a 10-year experience

Chang

Law

et al. 2011

Gastric Cancer

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Background The Intergroup 0116 study demonstrated that concurrent chemoradiation improved overall survival (OS) in resected gastric cancer. However, there are few reports focusing on late toxicity and factors governing prognosis. This study aimed to determine these two important aspects for employing this regimen. Methods Patients with resected gastric cancer stage IB to IV (M0) disease, treated between July 1998 and December 2007, were analyzed. The majority of the patients were treated using 5 cycles of 5-fluorouracil (5FU)/leucovorin chemotherapy with 45 Gy/25 fractions radiotherapy concurrent with cycles 2 and 3, as per the Intergroup 0116 study. Results We treated 120 patients (107 standard protocol, 13 with concurrent 5FU alone), and 14% had a close or positive margin. Median age was 59 years (35-79 years). Acute toxicity C grade 3 was seen in 66% of all patients (hematological 61%, stomatitis 3%, diarrhea 6%, vomiting 2%). Median follow-up was 33 months (range 6-125 months). Five-year OS and relapse-free survival were 51 and 54%, respectively. On multivariate analysis, surgical margin status, stage of the disease, and radiotherapy with computed tomography (CT) planning were important prognostic factors. Anemia and gastritis were the two most frequently occurring late complications, though they were usually mild and asymptomatic. Clinically significant renal impairment was uncommon. Other rare complications included intestinal obstruction, malabsorption, hypertension, and secondary malignancy. Conclusions Postoperative chemoradiation is safe and late toxicity is usually mild in extent. Results were comparable to the Intergroup 0116 study. R0 resection is of utmost importance and radiotherapy should best be delivered by conformal techniques.

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“…In a study conducted by Minn et al (2010) liver doses were lower with IMRT while no statistically significant difference was observed for liver and PTV doses. Milano et al (2006) compared 2D, 3D and IMRT; PTV dose appeared better with IMRT and kidney and liver doses were lower. In a study by Alani et al (2009) comparing 3D and IMRT no significant difference was observed for PTV doses, IMRT was only marginally better than 3D conformal radiotherapy at protecting spinal cord and kidneys from radiation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 2-Dimensional and 3-Dimensional Conformal Treatment Plans in Gastric Cancer Radiotherapy

Adaş¹,

Andrieu²,

Hiçsönmez³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 15 (17), 7401-7405 IntroductionGastric cancer is the fourth common cancer worldwide and is the second leading cause of death from cancer (Qurieshi et al., 2011;Zare et al., 2013;Calik et al., 2014;Oh et al., 2014). At present complete resection is the only curative therapy (Yu et al., 2013). 25-40% of the patients are suitable for curative surgery. Postoperative local recurrence is an important issue; 38% loco regional recurrence and 28% peritoneal spread are observed post operatively (Czito et al., 2013). Intergroup 0116 study (INT 0116) demonstrated significance of post-operative RT in gastric cancer. Following a 10 year-follow-up period, a significant benefit was observed in relapse free survival and in overall survival (Smalley et al., 2012). Based on the results of this study, post-operative chemoradiotherapy became a standard procedure in stage IB-IV M0 patients. Because of the critical organs in the vicinity, which are low in tolerance, planning of RT in gastric cancer is important (Czito et al., 2013). In this study 2D and 3D therapy plannings were compared in terms of dosimetric parameters. The aim was to assess the field efficiency of the 2D plan and to evaluate the 3D plan in terms of both its coverage of the target volume and its effect to decrease the normal tissue doses.

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Intensity-modulated radiation therapy in the treatment of gastric cancer: early clinical outcome and dosimetric comparison with conventional techniques

Cited by 84 publications

References 18 publications

Image-guided intensity-modulated radiotherapy for patients with locally advanced gastric cancer: a clinical feasibility study

Image-guided intensity-modulated radiotherapy for patients with locally advanced gastric cancer: a clinical feasibility study

Adjuvant chemoradiation for resected gastric cancer: a 10-year experience

Comparison of 2-Dimensional and 3-Dimensional Conformal Treatment Plans in Gastric Cancer Radiotherapy

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