IMRT for postoperative treatment of gastric cancer: covering large target volumes in the upper abdomen: a comparison of a step-and-shoot and an arc therapy approach

International Journal of Radiation Oncology, Biology, Physics
Petra WielandFrank Lohr

Abstract

Data from the randomized Intergroup Trial 116 suggest effectiveness of adjuvant radiochemotherapy in patients with advanced gastric cancer. Late toxicity, however, especially with respect to the kidneys, may pose significant longtime problems. Intensity-modulated radiotherapy (IMRT) may reduce toxicity to organs at risk. To evaluate the relative merits of different IMRT approaches, we performed a plan comparison between a step-and-shoot class solution and an AP-PA setup, a conventional box technique and the Peacock tomotherapy approach. Computed tomographies and structure data from 15 patients who had been treated postoperatively for advanced (T3/T4/N+) gastric cancer at our department formed the basis of our plan comparison study. For each patient data set, 5 plans or plan combinations (conventional 3D plan, AP-PA plan, step-and-shoot IMRT, tomotherapy with 1-cm or 2-cm collimation) were chosen, and evaluation was performed for a total dose of 45 Gy delivered as the median dose to the target volume for each plan or plan combination. Median kidney dose generated from the IMRT plans is reduced individually by >50% for the kidney with the highest exposure (usually the left kidney) from 20 to 30 Gy with conventional 3D planning do...Continue Reading

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