Intensity modulated radiotherapy in abdominal malignancies: Our experience in reducing the dose to normal structures as compared to the gross tumor

Kataria, Tejinder; Rawat, Sheh; Sinha, Sudha; Negi, P S; Garg, Chanchal; Bhalla, N.; Munjal, R.K.

doi:10.4103/0973-1482.29825

Cited by 10 publications

(5 citation statements)

References 10 publications

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“…The tendency of reduction in doses to OARs with IMRT obtained in this study was similar to that of earlier studies reported by Milano et al [23] and Kataria et al [24]. …”

Section: Discussionsupporting

confidence: 92%

Evaluation of dose coverage to target volume and normal tissue sparing in the adjuvant radiotherapy of gastric cancers: 3D-CRT compared with dynamic IMRT

Kk¹,

Ka²,

Ss³

et al. 2010

Biomed. Imaging Interv. J.

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Purpose:To assess the potential advantage of intensity-modulated radiotherapy (IMRT) over 3D-conformal radiotherapy (3D-CRT) planning in postoperative adjuvant radiotherapy for patients with gastric carcinoma.Methods and materials:In a retrospective study, for plan comparison, dose distribution was recalculated in 15 patients treated with 3D-CRT on the contoured structures of same CT images using an IMRT technique. 3D-conformal plans with three fields and four-fields were compared with seven-field dynamic IMRT plans. The different plans were compared by analyzing the dose coverage of planning target volume using TV95, Dmean, uniformity index, conformity index and homogeneity index parameters. To assess critical organ sparing, Dmean, Dmax, dose to one-third and two-third volumes of the OARs and percentage of volumes receiving more than their tolerance doses were compared.Results:The average dose coverage values of PTV with 3F-CRT and 4F-CRT plans were comparable, where as IMRT plans achieved better target coverage(p<0.001) with higher conformity index value of 0.81±0.07 compared to both the 3D-CRT plans. The doses to the liver and bowel reduced significantly (p<0.001) with IMRT plans compared to other 3D-CRT plans. For all OARs the percentage of volumes receiving more than their tolerance doses were reduced with the IMRT plans.Conclusion:This study showed that a better target coverage and significant dose reduction to OARs could be achieved with the IMRT plans. The IMRT can be preferred with caution for organ motion. The authors are currently studying organ motion in the upper abdomen to use IMRT for patient treatment.

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“…The tendency of reduction in doses to OARs with IMRT obtained in this study was similar to that of earlier studies reported by Milano et al [23] and Kataria et al [24]. …”

Section: Discussionsupporting

confidence: 92%

Evaluation of dose coverage to target volume and normal tissue sparing in the adjuvant radiotherapy of gastric cancers: 3D-CRT compared with dynamic IMRT

Kk¹,

Ka²,

Ss³

et al. 2010

Biomed. Imaging Interv. J.

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“…However, outcome studies in pancreatic cancer are mixed, in particular emphasizing the importance of narrow (1-cm) margins in PTVs, careful control of organ motion with respiration and exact positioning across fractions to maintain acute tissue toxicities within tolerable limits [5,11,13]. Outcome data for IMRT in gastric cancer are promising, but inconclusive due to small patient numbers [21,22].…”

Section: Expert Commentarymentioning

confidence: 96%

“…Kataria and colleagues used adjuvant IMRT to treat 11 patients with abdominal malignancies, three of whom had locally advanced gastric cancer [22]. Treatment volumes included a 1-cm extension beyond the gross tumor plus the drainage areas of the tumor bed with an additional 3-4-mm margin to account for organ motion.…”

Section: Treatment/outcome Studiesmentioning

confidence: 99%

Role of intensity-modulated radiation therapy in gastrointestinal cancer

Bockbrader

Kim²

2009

Expert Review of Anticancer Therapy

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Intensity-modulated radiation therapy (IMRT) represents a powerful advance in the planning and delivery of radiation therapy owing to its ability to deliver highly conformal treatment doses while sparing normal tissues. Dosimetric studies have shown the feasibility and theoretical benefit of treating with IMRT over 3D-conformal radiation therapy in gastrointestinal malignancies. Early clinical experience with IMRT in the treatment of gastric, pancreatic, rectal and anal cancers corroborates the dosimetric analyses, with some series reporting lower normal tissue toxicities. This article reviews the radiobiological, physical, technical and clinical aspects of IMRT for gastric, pancreatic, rectal and anal cancer, and summarizes the dosimetric and outcome studies to date.

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“…IMRT is therefore superior to 3-D CRT in maximizing homogeneous radiation to the planned target volume, while minimizing the damage to adjacent normal tissues. 13 , 14 Helical tomotherapy (HT) is a type of IMRT that allows for adjustment of the planned target volume using real-time treatment monitoring by diagnostic computed tomography (CT) systems. 15 However, there have been no randomized trials comparing IMRT and 3-D CRT in terms of GI toxicities and other outcomes.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Gastrointestinal Toxicities between Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Pancreatic Cancer

et al. 2016

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Background/AimsConcurrent chemoradiotherapy (CCRT) is considered the treatment option for locally advanced pancreatic cancer, but accompanying gastrointestinal toxicities are the most common complication. With the introduction of three-dimensional conformal radiotherapy (3-D CRT) and intensity-modulated radiotherapy (IMRT), CCRT-related adverse events are expected to diminish. Here, we evaluated the benefits of radiation modalities by comparing gastrointestinal toxicities between 3-D CRT and IMRT.MethodsPatients who received CCRT between July 2010 and June 2012 in Severance Hospital, Yonsei University College of Medicine, were enrolled prospectively. The patients underwent upper endoscopy before and 1 month after CCRT.ResultsA total of 84 patients were enrolled during the study period. The radiotherapy modalities delivered included 3D-CRT (n=40) and IMRT (n=44). The median follow-up period from the start of CCRT was 10.6 months (range, 3.8 to 29.9 months). The symptoms of dyspepsia, nausea/vomiting, and diarrhea did not differ between the groups. Upper endoscopy revealed significantly more gastroduodenal ulcers in the 3-D CRT group (p=0.003). The modality of radiotherapy (3D-CRT; odds ratio [OR], 11.67; p=0.011) and tumor location (body of pancreas; OR, 11.06; p=0.009) were risk factors for gastrointestinal toxicities.ConclusionsIMRT is associated with significantly fewer gastroduodenal injuries among patients treated with CCRT for pancreatic cancer.

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Intensity modulated radiotherapy in abdominal malignancies: Our experience in reducing the dose to normal structures as compared to the gross tumor

Abstract: IMRT with inverse planning enabled us to achieve desired dose distribution, due to its ability to provide sharp dose gradients at the junction of tumor and the adjacent critical organs.

Cited by 10 publications

References 10 publications

Evaluation of dose coverage to target volume and normal tissue sparing in the adjuvant radiotherapy of gastric cancers: 3D-CRT compared with dynamic IMRT

Evaluation of dose coverage to target volume and normal tissue sparing in the adjuvant radiotherapy of gastric cancers: 3D-CRT compared with dynamic IMRT

Role of intensity-modulated radiation therapy in gastrointestinal cancer

A Comparison of Gastrointestinal Toxicities between Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Pancreatic Cancer

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