Comparisons between the Dosimetric and Clinical Outcomes of Tomotherapy and 3D Conformal Radiotherapy in Gastric Cancer Treatment

Abstract

Introduction:Previous studies comparing tomotherapy (TOMO) and three dimensional (3D) conformal radiotherapy (3DCRT) in gastric radiotherapy are limited and tend to be based on dosimetry. The aim of the present study was to evaluate the clinical outcomes of these two treatment modalities. Methods:A total of 51 patients diagnosed with gastric cancer who were treated with postoperative adjuvant chemoradiotherapy and had subtotal/total gastrectomy and D2 lymphatic dissection were recruited to the present study: 30 patients were treated with TOMO and 21 patients were treated with 3DCRT.Results:The 3DCRT and TOMO treatment regimens were compared. There was no difference in planning target volume (PTV) 95%, but TOMO was statistically significant in regard to PTV 105% (P<0.05). TOMO was also significantly different when compared with 3DCRT when evaluating liver mean dose, liver V40, right/left kidneys mean dose, right/left kidneys V20 and spinal cord mean dose values (P<0.05). Grade 2 acute side effects were more frequent (85.7%) following 3DCRT. In addition, the median overall survival time for TOMO treated patients was 62 months while in 3DCRT treated patients it was 22.05 months. The difference in disease free survival was also significantly increased in patients treated with TOMO (66.7% vs. 19.0%; P<0.05). Conclusion:TOMO treatment resulted in lower acute side effects with better patient survival following gastric cancer radiotherapy.

Evidence Mapping of Proton Therapy, Heavy Ion Therapy, and Helical Tomotherapy for Gastric Cancer

“…There were 46 records were retrieved for full-text evaluation, while 32 studies were excluded because 10 records were not about GC, 7 studies not used PT, HIB therapy, or TOMO as radiotherapy measures, 9 studies were about GC radiotherapy dosimetry research, 2 studies [16, 17] were about GC cell irradiation research, and 2 were repeated. Eventually, there were 14 studies [18-31] met the eligible criteria were included for qualitative analysis, of which ten studies [18-20, 22-26, 28, 29] researched GC radiotherapy, 4 studies [21, 27, 30, 31] were about LMGC radiotherapy.…”

“…And all studies with a language of English. Study sites were indicated in 7 [18, 20, 21, 25, 27, 29, 31] studies and research periods were described in 8 studies [20, 21, 25, 27, 29-31]. As to intervention measures, 85.7% (12/14) of included studies were single arm without comparison tests.…”

“…Figure 3 showed that there were 2 prospective cohort studies [22, 25] with radiation measures respectively including TOMO alone and TOMO versus 3-dimensional conformal radiation (3D-CRT), 5 retrospective cohort studies [21, 27, 29-31] with 4 PT alone and 1 TOMO versus 3D-CRT, 3 case reports [18-20] with PT alone, 1 systematic review [26] assessed PT alone, 3 reviews [23, 28] with 3 evaluated PT alone.…”

“…There were 3 original studies [22, 25, 29] researched the treatment efficacy of TOMO for GC, of which one were single-arm study [22] presented TOMO alone and 2 [25, 29] were double-arm about TOMO versus 3D-CRT. One research [22] including 19 patients which performed an intervention of TOMO administered adjuvant chemotherapy showed that 53% and 68% of patients occurred Grade I and II GI and hematological (HL) toxicity respectively, and 5.5% as well as 11% occurred Grade III and IV GI and HL toxicity severally.…”

“…One research [22] including 19 patients which performed an intervention of TOMO administered adjuvant chemotherapy showed that 53% and 68% of patients occurred Grade I and II GI and hematological (HL) toxicity respectively, and 5.5% as well as 11% occurred Grade III and IV GI and HL toxicity severally. As to the rest of 2 researches [25, 29] with interventions of TOMO and 3D-CRT, they both used a total dose of 45 Gy in 25 fractions as well as conducted chemotherapy, and 1 research [25] showed both TOMO and 3D-CRT were similar in 3-year OS, 3-year PFS, median LC, and occurrence of toxicity, except TOMO with lesser relapse and death, and improved OARs sparing. However, the other study [29] published in 2019 presented that there were longer median OS and PFS, lower occurrence of Grade III toxicity and late toxicity, better in improving OARs sparing as well as lesser death with the intervention of TOMO than 3D-CRT.…”