Radiation treatment planning techniques for lymphoma of the stomach

Biancia, Cesar Della; Hunt, Margie; Furhang, E; Wu, Elisa; Yahalom, Joachim

doi:10.1016/j.ijrobp.2004.10.025

Cited by 54 publications

(34 citation statements)

References 18 publications

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“…It is recommended to treat patients with such protocols 118 119. Using 3D conformal radiotherapy and intensity-modulated radiation therapy (IMRT) enables the kidney dose to be decreased compared with parallel opposed beams 120. In addition, stomach distension can be minimised by treating the patient in a fasting state.…”

Section: Treatmentmentioning

confidence: 99%

EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT

Ruskoné-Fourmestraux

Fischbach

Aleman

et al. 2011

Gut

333

375

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Section: Treatmentmentioning

confidence: 99%

EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT

Ruskoné-Fourmestraux

Fischbach

Aleman

et al. 2011

Gut

333

375

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“…9–12 One approach is to add an adequate margin to the clinical target volume (CTV), so the involved site is encompassed within the treatment volume throughout the normal respiratory cycle 8,13 ; however, the resulting large planning target volume (PTV) may cause the delivery of excess dose to surrounding normal structures. 3,14 Techniques that reduce the effect of organ motion during RT include the use of external respiratory restraining devices, 9 gating, 15–17 and breath-hold. 18 For example, Wagman et al found that the PTV margin could be reduced from 2 to 1 cm if patients held their breath, rather than breathing freely, during RT for liver tumors.…”

Section: Introductionmentioning

confidence: 99%

Daily CT guidance improves target coverage during definitive radiation therapy for gastric MALT lymphoma

Milgrom

Dabaja

et al. 2017

Practical Radiation Oncology

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Purpose Radiation therapy (RT) for gastric mucosa–associated lymphoid tissue (MALT) lymphoma is challenging because of variation in the stomach’s position, size, and shape. We investigated the interfractional changes in stomach location, consequent dosimetric effects, and impact of daily computed tomography image guidance RT (CT-IGRT). Methods and materials Twelve patients treated for gastric MALT lymphoma with intensity modulated radiation therapy, using a breath-hold technique and restriction of oral intake, were studied retrospectively. The planning target volume (PTV) comprised a 0.5 to 1.0 cm expansion of the stomach. The prescription dose was 30 Gy in 15 to 20 fractions. CT-IGRT was performed daily using CT-on-Rails. Dosimetry was calculated on 229 daily CT images after bony versus CT-based soft tissue alignment, and doses delivered to the target and adjacent structures were compared with the treatment plan. Target coverage was expressed as the percent of the clinical target volume (CTV) and PTV receiving ≥95% of the prescribed dose (V95%). Results The average change in stomach volume was −12.4% (range, −47.6% to 38.6%). The average shift required for target coverage was 1.0 cm (maximum, 2.2 cm). With CT-based alignment to the stomach, the average V95% was 98.5% for CTV and 94.9% for PTV; with bony alignment, these values were 94.5% and 90.4%, respectively (P < .01 for CTV and PTV). With bony alignment, the PTV V95% was ≤90% in 4 patients (33%) over the course of treatment and was as low as 72.5% for 1 fraction. The kidney position varied with respect to the stomach and bony anatomy. Consequently, the dose to the left kidney was higher based on daily CT scans than on planning scans. Dose to other organs at risk did not vary significantly. Conclusions Substantial interfractional variation in stomach volume was observed, despite treatment with breath-hold and restriction of oral intake. Daily CT-IGRT improved target coverage, enabling excellent coverage despite the use of small PTV margins.

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“…In cases with a large overlap between the kidney and the PTV, it is difficult to protect the kidney when using radiation of AP/PA opposing fields; in these cases, 3D conformal radiation therapy (3DCRT) is more advantageous. Use of IMRT might lead to further improvement for the left kidney and liver doses [12]. Additionally, Ringash et al reported a five-fields technique for postoperative radiotherapy of gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy for gastric lymphoma: a planning study of 3D conformal radiotherapy, the half-beam method, and intensity-modulated radiotherapy

Inaba¹,

Okamoto²,

Wakita³

et al. 2014

Journal of Radiation Research

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During radiotherapy for gastric lymphoma, it is difficult to protect the liver and kidneys in cases where there is considerable overlap between these organs and the target volume. This study was conducted to compare the three radiotherapy planning techniques of four-fields 3D conformal radiotherapy (3DCRT), half-field radiotherapy (the half-beam method) and intensity-modulated radiotherapy (IMRT) used to treat primary gastric lymphoma in which the planning target volume (PTV) had a large overlap with the left kidney. A total of 17 patients with gastric diffuse large B-cell lymphoma (DLBCL) were included. In DLBCL, immunochemotherapy (Rituximab + CHOP) was followed by radiotherapy of 40 Gy to the whole stomach and peri-gastric lymph nodes. 3DCRT, the half-field method, and IMRT were compared with respect to the dose–volume histogram (DVH) parameters and generalized equivalent uniform dose (gEUD) to the kidneys, liver and PTV. The mean dose and gEUD for 3DCRT was higher than for IMRT and the half-beam method in the left kidney and both kidneys. The mean dose and gEUD of the left kidney was 2117 cGy and 2224 cGy for 3DCRT, 1520 cGy and 1637 cGy for IMRT, and 1100 cGy and 1357 cGy for the half-beam method, respectively. The mean dose and gEUD of both kidneys was 1335 cGy and 1559 cGy for 3DCRT, 1184 cGy and 1311 cGy for IMRT, and 700 cGy and 937 cGy for the half-beam method, respectively. Dose–volume histograms (DVHs) of the liver revealed a larger volume was irradiated in the dose range <25 Gy with 3DCRT, while the half-beam method irradiated a larger volume of liver with the higher dose range (>25 Gy). IMRT and the half-beam method had the advantages of dose reduction for the kidneys and liver.

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Radiation treatment planning techniques for lymphoma of the stomach

Cited by 54 publications

References 18 publications

EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT

EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT

Daily CT guidance improves target coverage during definitive radiation therapy for gastric MALT lymphoma

Radiotherapy for gastric lymphoma: a planning study of 3D conformal radiotherapy, the half-beam method, and intensity-modulated radiotherapy

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