Limited Advantages of Intensity-Modulated Radiotherapy Over 3D Conformal Radiation Therapy in the Adjuvant Management of Gastric Cancer

Alani, Shlomo; Soyfer, Viacheslav; Strauss, Natan; Schifter, Dan; Corn, Benjamin W.

doi:10.1016/j.ijrobp.2008.09.061

Cited by 37 publications

(31 citation statements)

References 22 publications

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“…Although IMRT does not provide a significant reduction in acute toxicity compared to con RT, it does spare the kidneys and liver, as demonstrated in this study as well as previous studies [11][12][13]. The sparing of critical organs is clinically very important because concurrent chemotherapy also affects the kidneys, liver, and parts of the spinal cord and because it reduces potential long-term toxicity, especially for patients undergoing major abdominal surgery and for those who may subsequently need further chemotherapy.…”

Section: Discussionsupporting

confidence: 58%

“…A previous comparison of patients treated with con RT or IMRT indicated that IMRT reduces the dose to the liver but does not reduce acute gastrointestinal toxicity [11]. This finding was supported by another study in which IMRT was also shown to provide better protection of the liver and kidneys compared with 3D CRT [12], although this conflicts with a study that showed only marginal sparing of the kidneys [13].…”

Section: Discussionmentioning

confidence: 95%

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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: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 95%

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

et al. 2013

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“…Intensity-modulated radiation therapy (IMRT) techniques may provide further incremental benefit with lower doses to normal structures being achieved, although the optimal way of adopting this continues to be investigated [61,62].…”

Section: Technical Considerations For Radiation Therapymentioning

confidence: 99%

Neoadjuvant or adjuvant therapy for resectable gastric cancer: a systematic review and practice guideline for North America

Knight

Earle²,

Cosby

et al. 2012

Gastric Cancer

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“…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. Though there is no explicit advantage of IMRT in PTV dose distribution when compared to 3D planning, because its normal tissue doses appeared to be lower, IMRT may be preferred for gastric cancer RT in experienced centers.…”

Section: Discussionmentioning

confidence: 93%

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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Limited Advantages of Intensity-Modulated Radiotherapy Over 3D Conformal Radiation Therapy in the Adjuvant Management of Gastric Cancer

Cited by 37 publications

References 22 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

Neoadjuvant or adjuvant therapy for resectable gastric cancer: a systematic review and practice guideline for North America

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

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