Conformal radiotherapy in the adjuvant treatment of gastric cancer: Review of 82 cases

Kassam, Zahra; Lockwood, Gina; O’Brien, Catherine; Brierley, James D.; Swallow, Carol J.; Oza, Amit M.; Siu, Lillian L.; Knox, Jennifer J.; Wong, Rebecca; Cummings, Bernard; Kim, John; Moore, Malcolm J.; Ringash, Jolie

doi:10.1016/j.ijrobp.2006.01.001

Cited by 46 publications

(32 citation statements)

References 33 publications

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“…In addition, 36% of patients were unable to complete therapy because of several factors, including toxicity, patient preference, and progression of disease. These levels of acute toxicity (and concomitant compliance) have been similar in other series, including in a review from our institution 3,15,16 . The INT-0116 study showed a 3-year os of 1 1 0 0 1 0 2 0 0 0 0 1 3 0 0 0 0 0 Dyspepsia/ heartburn 1 3 2 3 3 2 2 0 0 2 2 2 3 0 0 0 0 0 Nausea 1 5 3 2 3 0 2 0 6 4 2 4 3 0 0 1 0 0 Vomiting 1 3 2 2 1 1 2 0 2 2 0 3 3 0 0 1 0 0 Gastritis/reflux 1 0 0 2 1 2 2 1 2 2 0 1 3 1 0 0 0 0 Abdominal pain 1 0 0 0 0 0 2 0 1 0 0 50% with adjuvant chemoradiation, compared with 41% for treatment with surgery alone.…”

Section: Discussionsupporting

confidence: 81%

“…Participants were treated according to institutional protocol with three-dimensional conformal planning and delivery 3,10 . The clinical target volume was defined using the criteria from the INT-0116 study 11 .…”

Section: Radiation Therapymentioning

confidence: 99%

“…A recent review of 82 patients with Union Internationale Contre le Cancer (uicc) stage ib to iv (M0) gastric adenocarcinoma treated at our institution showed a 3-year overall survival (os) of 69% (95% confidence interval: 55% to 82%) 3 . Despite the use of three-dimensional conformal radiation techniques, toxicity remained comparable to that seen in the Intergroup study.…”

Section: Introductionmentioning

confidence: 99%

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Adjuvant Chemoradiation for Gastric Cancer with Infusional 5-Fluorouracil and Cisplatin: A Phase I Study

et al. 2010

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ObjectiveThis phase i study aimed to determine the maximal tolerated dose of cisplatin administered every 2 weeks with infusional 5-fluorouracil (5fu) and concurrent radiation therapy (rt) in patients after complete resection of gastric adenocarcinoma. MethodsPatients with resected stage ib to iv (M0) gastric adenocarcinoma were treated with 12 weeks of infusional 5fu (200 mg/m 2 daily) and with rt (45 Gy in 25 fractions starting on day 16). Cisplatin was administered in escalating doses (0,20, 30, and 40 mg/m 2 ) in weeks 1, 3, 5, and 7. In the final cohort, patients received an additional dose of cisplatin (40 mg/m 2 ) in week 9. ResultsAmong the 34 patients [median age: 56 years (range: 31-77 years)] who were assessable for toxicity, 5 experienced dose-limiting toxicities: 1 sepsis (cohort 1), 1 fatigue (cohort 2), 3 upper gastrointestinal toxicity (1 in cohort 2, 2 in cohort 5). Cohort 5 exceeded the maximal tolerated dose. Median follow-up was 2.5 years (range: 0.3-5 years). The 3-year overall and relapse-free survival rates were 86% and 71% respectively; median survival was not reached. ConclusionsCisplatin was well tolerated in combination with infusional 5fu and rt, showing promising activity in the adjuvant treatment of gastric cancer. Infusional 5fu 200 mg/m 2 daily for 12 weeks with cisplatin 40 mg/m 2 in weeks 1, 3, 5, and 7 and with concurrent rt 45 Gy in 25 fractions, starting at day 16, is being explored in a phase ii study at our institution.

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Section: Discussionsupporting

confidence: 81%

Section: Radiation Therapymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adjuvant Chemoradiation for Gastric Cancer with Infusional 5-Fluorouracil and Cisplatin: A Phase I Study

et al. 2010

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“…However, previous randomized studies have reported significantly higher rates of hematologic and gastrointestinal toxicity with chemoradiotherapy [8,10,27]. Late toxicity after chemoradiotherapy to the upper abdomen includes bowel strictures [16,27] and radiation-induced nephropathy, which may manifest months to years post-treatment [7,15]. Measures to reduce toxicity include omitting prophylactic radiotherapy of regional lymph nodes [27], decreasing mobility margins by individualized assessment and incorporation of target mobility [33], and the use of more conformal radiotherapy techniques.…”

Section: Introductionmentioning

confidence: 99%

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

et al. 2010

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Background: Intensity-modulated radiotherapy (IMRT) allows for improved sparing of organs at risk (OARs) in advanced pancreatic cancer. A planning study evaluated if volumetric modulated arc therapy (RapidArc™ [RA]) could be used as an alternative to IMRT in such cases. Patients and Methods: In ten patients, five-field IMRT (5f-IMRT) plans with fixed gantry positions were compared to RA plans using similar constraints for planning target volume (PTV) and OARs. PTV coverage, conformity indices (CI), and OAR doses were compared. One patient was treated using RA and calculated dose distributions were measured in coronal planes in a solid-water phantom. Results: RA plans showed superior mean CI of 1.09 ± 0.02 (± 1 SD [standard deviation]) versus 1.20 ± 0.10 in 5f-IMRT (p = 0.003). Both techniques achieved similar sparing of the right kidney, but RA significantly reduced left kidney doses with V 15 of 7.2% ± 5.3% and 15.9% ± 11.1%, respectively; p = 0.02. RA modestly decreased mean doses to liver (13.8 vs. 15.1 Gy; p = 0.003), stomach (16.7 vs. 17.9 Gy; p = 0.017), small bowel (19.8 vs. 22.1 Gy; p < 0.001), and duodenum (38.8 vs. 41.9 Gy; p = 0.004). Film dosimetry revealed excellent agreement between calculated and measured dose distributions. The delivery time for RA was < 3 min. Conclusion: RA planning achieved superior CI for pancreatic tumors compared to 5f-IMRT, and modestly reduced OAR doses. Fast treatment delivery using RA may decrease the risk of intrafractional organ motion. Ergebnisse: RA-Pläne zeigten einen günstigeren CI von 1,09 ± 0,02 (± 1 SD [Standardabweichung]) gegenüber 1,20 ± 0,10 bei 5f-IMRT (p = 0,003). Mit beiden Techniken gelang eine zufriedenstellende Dosisreduktion der rechten Niere, mittels RA konnten jedoch die V 15 der linken Niere signifikant reduziert werden (7,2% ± 5,3% vs. 15,9% ± 11,1% bei IMRT; p = 0,02). Geringer zeigte sich die Reduktion der mittleren Dosis der Leber (13,8 vs. 15,1 Gy; p = 0,003), des Magens (16,7 vs. 17,9 Gy; p = 0,017), des Dünndarms (19,8 vs. 22,1 Gy; p < 0,001) und des Duodenums (38,8 vs. 41,9 Gy; p = 0,004). Filmdosimetrische Überprüfungen zeigten hervorragende Übereinstimmungen bezüglich kalkulierter und tatsächlicher Dosisverteilung. Die Gesamtbestrahlungszeit betrug < 3 min. Schlussfolgerung: Mittels RA-Planung lässt sich im Vergleich zur 5f-IMRT sowohl ein günstigerer CI als auch moderate Dosisreduktion in den OAR erreichen. Durch die rasche Dosisapplikation vermindert sich das Risiko intrafraktionärer Bewegung der OAR.Schlüsselwörter: Pankreaskarzinom · "Volumetric modulated arc therapy" · Intensitätsmodulierte Radiotherapie · Planungsstudie · Risikoorgane

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“…Meanwhile, throughout North America and much of Europe, D2 and more extensive nodal dissections remain the exception; the majority of patients are treated in the community, often by general surgeons. For example, in Toronto, Canada, 82 patients treated with post-operative adjuvant therapy for gastric cancer were operated on at 16 different hospitals, with only 6% receiving D2+ nodal dissections [6]. Analysis of the surgery in the Intergroup 0116 study of adjuvant chemoradiotherapy showed that 88% of cases were MI > 5 [7].…”

Section: To the Editormentioning

confidence: 99%