Three-Dimensional Non-Coplanar Conformal Radiotherapy Yields Better Results Than Traditional Beam Arrangements for Adjuvant Treatment of Gastric Cancer

Viacheslav Soyfer*, Benjamin W. Corn, Alex Melamud, Shlomi Alani, Haim Tempelhof, Reuben Agai, Anat Shmueli, Arie Figer, Felix Kovner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Purpose: The current standard of adjuvant treatment for gastric cancer after curative resection is concurrent administration of radiotherapy and 5-fluorouracil-based chemotherapy. The radiation fields are often arranged as anterioposterior-posteroanterior opposed parallel fields with general recommendations for sparing at least two-thirds of one kidney. We investigated whether a better radiation distribution would be achievable with three-dimensional conformal approaches compared with the classic anterioposterior-posteroanterior fields. Methods and Materials: A total of 19 patients with adenocarcinoma of the stomach were treated with adjuvant chemoradiotherapy using a non-coplanar four-field arrangement. In each case, parallel planning using an anterioposterior-posteroanterior arrangement and a four-field "box" was performed, and the generated plans were subsequently compared for coverage of target volumes and doses to irradiated organs next to the tumor bed. A separate analysis was performed for kidneys exposed to greater and lower doses in each patient. The mean radiation dose and percentage of kidney volume receiving a dose >20 Gy were registered. Statistical analysis was performed using the two-tailed t test. Results: The clinical target volume was adequately covered in all three plans. In the greater-dose kidney group, all the differences were statistically significant with a benefit for the three-dimensional plan. In the lower-dose kidney group, the differences in the mean radiation dose did not reach the level of statistical significance, and the differences in the kidney volume receiving a dose >20 Gy showed a statistically significant benefit for the three-dimensional plan. Conclusion: Non-coplanar three-dimensional-based conformal planning for postoperative radiotherapy for gastric cancer provided the best results regarding kidney and spinal cord exposure with adequate clinical target volume coverage. This technique was readily implemented in clinical practice.

Original languageEnglish
Pages (from-to)364-369
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume69
Issue number2
DOIs
StatePublished - 1 Oct 2007
Externally publishedYes

Keywords

  • Gastric cancer
  • Renal sparing radiotherapy

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