Comparison of Intensity-Modulated Radiotherapy and 3-Dimensional Conformal Radiotherapy as Adjuvant Therapy for Gastric Cancer
Comparison of Intensity-Modulated Radiotherapy and 3-Dimensional Conformal Radiotherapy as Adjuvant Therapy for Gastric Cancer
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DOI：
10.1002/cncr.25246
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发表时间：
2010-08-15
期刊：
影响因子：
6.2
通讯作者：
Chang, Daniel T.
中科院分区：
文献类型：
--
作者：
Minn, A. Yuriko;Hsu, Annie;Chang, Daniel T.
背景：本研究旨在比较胃癌术后化疗患者使用调强放疗（IMRT）与三维适形放疗（3D CRT）的临床结果和毒性。方法：对57例胃或胃食管结癌患者进行术后治疗，其中3D CRT 26例，IMRT 31例。同期化疗为卡培他滨（n = 31）、5-氟尿嘧啶（5-FU） （n = 25）或无化疗（n = 1）。中位辐射剂量为45 Gy。比较两组间肾、肝的剂量体积直方图参数。结果：3D CRT与IMRT的2年总生存率分别为51%和65% （P = 0.5）。在3D CRT（15%）和IMRT（13%）患者中各发生4例局部失败。发现>= 2级急性胃肠道毒性在3D CRT和IMRT患者之间相似（分别为61.5%和61.2%），但需要更多的治疗时间（分别为3和0）。IMRT组的中位血清肌酐从放疗前到最近的肌酐没有变化（0.80 mg/dL），而3D CRT组从0.80 mg/dL增加到1.0 mg/dL （P = 0.02）。IMRT组肾脏平均中位剂量高于3D CRT组（13.9 Gy vs 11.1 Gy; P = 0.05）。与3D CRT组相比，IMRT组中位肾V20较低（17.5% vs 22%; P = 0.17）。IMRT和3D CRT的肝脏平均中位剂量分别为13.6 Gy和18.6 Gy （P = 0.19）。肝V30中位数分别为16.1%和28% （P < 0.001）。结论：辅助放化疗耐受良好。研究发现，IMRT对肝脏和可能的肾功能有保护作用。癌症2010;116:3943-52。(C) 2010年美国癌症协会
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. Cancer 2010;116:3943-52. (C) 2010 American Cancer Society