Benefit of volumetric-modulated arc therapy over three-dimensional conformal radiotherapy for stage I-II extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue in the stomach: a dosimetric comparison

Abstract

PurposeTo retrospectively analyze dosimetric parameters of volumetric-modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3D-CRT) delivered to extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue in the stomach (gastric MALT lymphoma) to find out advantages of VMAT and conditions for definite benefits of VMAT.Materials and MethodsFifty patients with stage I-II gastric MALT lymphoma received VMAT (n = 14) or 3D-CRT (n = 36) between December 2005 and April 2018. Twenty-seven patients were categorized according to whether the planning target volume (PTV) overlaps kidney(s). Dosimetric parameters were analyzed by dose-volume histogram.ResultsRadiation dose to the liver was definitely lower with VMAT in terms of mean dose (p = 0.026) and V15 (p = 0.008). The V15 of the left kidney was lower with VMAT (p = 0.065). For those with PTV overlapping kidney(s), the left kidney V15 was significantly lower with VMAT. Furthermore, the closer the distance between the PTV and kidneys, the less the left kidney V15 with VMAT (p = 0.037). Delineation of kidney(s) by integrating all respiratory phases had no additional benefit.conclusionsVMAT significantly increased monitor units, reduced treatment time and radiation dose to the liver and kidneys. The benefit of VMAT was definite in reducing the left kidney V15, especially in geometrically challenging conditions of overlap or close separation between PTV and kidney(s).

Combining deep-inspiration breath hold and intensity-modulated radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma: Dosimetric evaluation using comprehensive plan quality indices

“…Although this involved-site radiation therapy uses low doses, the doses to the organs-at-risk (OARs) near the stomach, such as the kidneys, small bowel, or liver, must be considered. To date, several planning techniques involving anterior-posterior/posterior-anterior fields (AP/PA) and 3-dimensional conformal radiotherapy (3D-CRT) have been used to reduce radiation exposure to the OARs to within tolerance limits, and intensity-modulated radiotherapy (IMRT) techniques for gastric MALToma have recently been introduced [10–15]. Despite the dosimetric advantages of these modalities in terms of the doses to the OARs, concerns regarding higher scattered doses have not been resolved [16].…”

Analysis of Chronic Kidney Disease After Radiation Therapy for Gastric/Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma

“…Compared with 3D-CRT, these recent techniques have the potential to reduce the kidney dose, especially in patients with anatomic overlap between their PTV and both kidneys. 32 , 33 In addition, other radiation techniques, such as breath-hold irradiation, are also useful. Because of the proximity of the stomach to the diaphragm, respiration can influence gastric motion.…”

Low Expression of GLIS2 Gene Might Associate with Radiosensitivity of Gastric Cancer

“…Based on extensive application of radiotherapy in clinical practice worldwide, many researchers have paid great attention to how to utilize radiotherapy to improve the life quality of patients with gastric cancer in different directions. Chung et al did retrospective analysis on the efficacy of treatment of gastric cancer by volumetric-modulated arc therapy (VMAT) and found that VMAT could effectively reduce the treatment time and the irradiation dose at the liver and kidney to alleviate the toxicity of radiotherapy [3]. Some clinical trials had focused on providing optimal radiotherapy strategies for patients with different stages of gastric cancer [4–7].…”