Comparison of intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy as adjuvant therapy for gastric cancer Journal Article

Authors: Minn, A. Y.; Hsu, A.; La, T.; Kunz, P.; Fisher, G. A.; Ford, J. M.; Norton, J. A.; Visser, B.; Goodman, K. A.; Koong, A. C.; Chang, D. T.
Article Title: Comparison of intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy as adjuvant therapy for gastric cancer
Abstract: BACKGROUND: The current study was performed to compare the clinical outcomes and toxicity in patients treated with postoperative chemoradiotherapy for gastric cancer using intensity-modulated radiotherapy (IMRT) versus 3-dimensional conformal radiotherapy (3D CRT). METHODS: Fifty-seven patients with gastric or gastroesophageal junction cancer were treated postoperatively: 26 with 3D CRT and 31 with IMRT. Concurrent chemotherapy was capecitabine (n = 31), 5-fluorouracil (5-FU) (n = 25), or none (n = 1). The median radiation dose was 45 Gy. Dose volume histogram parameters for kidney and liver were compared between treatment groups. RESULTS: The 2-year overall survival rates for 3D CRT versus IMRT were 51% and 65%, respectively (P = .5). Four locoregional failures occurred each in the 3D CRT (15%) and the IMRT (13%) patients. Grade ≥2 acute gastrointestinal toxicity was found to be similar between the 3D CRT and IMRT patients (61.5% vs 61.2%, respectively) but more treatment breaks were needed (3 vs 0, respectively). The median serum creatinine from before radiotherapy to most recent creatinine was unchanged in the IMRT group (0.80 mg/dL) but increased in the 3D CRT group from 0.80 mg/dL to 1.0 mg/dL (P = .02). The median kidney mean dose was higher in the IMRT versus the 3D CRT group (13.9 Gy vs 11.1 Gy; P = .05). The median kidney V20 was lower for the IMRT versus the 3D CRT group (17.5% vs 22%; P = .17). The median liver mean dose for IMRT and 3D CRT was 13.6 Gy and 18.6 Gy, respectively (P = .19). The median liver V30 was 16.1% and 28%, respectively (P < .001). CONCLUSIONS: Adjuvant chemoradiotherapy was well tolerated. IMRT was found to provide sparing to the liver and possibly renal function. © 2010 American Cancer Society.
Keywords: adult; cancer chemotherapy; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; surgical technique; treatment failure; major clinical study; overall survival; histopathology; cancer localization; intensity modulated radiation therapy; postoperative period; fluorouracil; diarrhea; capecitabine; adjuvant therapy; cancer adjuvant therapy; cancer radiotherapy; disease free survival; radiation dose; combined modality therapy; radiotherapy, adjuvant; anorexia; carboplatin; multiple cycle treatment; blood toxicity; esophagitis; nausea; vomiting; antineoplastic combined chemotherapy protocols; weight reduction; creatinine; creatinine blood level; gastrointestinal toxicity; liver; kidney; radiotherapy, intensity-modulated; dosimetry; radiation dose fractionation; stomach ulcer; gastrectomy; jaundice; stomach cancer; epirubicin; radiotherapy, conformal; oxaliplatin; esophagus cancer; stomach neoplasms; esophagus stricture; creatinine clearance; histogram; small intestine perforation; gastric; total stomach resection; intensity-modulated radiotherapy (imrt); radiation outcomes; esophagogastrectomy; gastroesophageal junction cancer; three dimensional conformal radiotherapy
Journal Title: Cancer
Volume: 116
Issue: 16
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2010-08-15
Start Page: 3943
End Page: 3952
Language: English
DOI: 10.1002/cncr.25246
PUBMED: 20564136
PROVIDER: scopus
Notes: --- - "Export Date: 20 April 2011" - "CODEN: CANCA" - "Source: Scopus"
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  1. Karyn A Goodman
    245 Goodman