PMID- 17889271
OWN - NLM
STAT- MEDLINE
DCOM- 20071129
LR  - 20191210
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 69
IP  - 3
DP  - 2007 Nov 1
TI  - A four-dimensional CT-based evaluation of techniques for gastric irradiation.
PG  - 903-9
AB  - PURPOSE: To evaluate three-dimensional conformal (3D-CRT), intensity-modulated 
      (IMRT) and respiration-gated radiotherapy (RGRT) techniques for gastric 
      irradiation for target coverage and minimization of renal doses. All techniques 
      were four-dimensional (4D)-CT based, incorporating the intrafractional mobility 
      of the target volume and organs at risk (OAR). METHODS AND MATERIALS: The 
      stomach, duodenal C-loop, and OAR (kidneys, liver, and heart) were contoured in 
      all 10 phases of planning 4D-CT scans for five patients who underwent abdominal 
      radiotherapy. Planning target volumes (PTVs) encompassing all positions of the 
      stomach (PTV(all phases)) were generated. Three respiratory phases for RGRT in 
      inspiration and expiration were identified, and corresponding PTV(inspiration) 
      and PTV(expiration) and OAR volumes were created. Landmark-based fields 
      recommended for the Radiation Therapy Oncology Group (RTOG) 99-04 study protocol 
      were simulated to assess PTV coverage. IMRT and 3D-CRT planning with and without 
      additional RGRT planning were performed for all PTVs, and corresponding dose 
      volume histograms were analyzed. RESULTS: Use of landmark-based fields did not 
      result in full geometric coverage of the PTV(all phases) in any patient. IMRT 
      significantly reduced mean renal doses compared with 3D-CRT (15.0 Gy +/- 0.9 Gy 
      vs. 20.1 Gy +/- 9.3 Gy and 16.6 Gy +/- 1.5 Gy vs. 32.6 Gy +/- 7.1 Gy for the left 
      and right kidneys, respectively; p = 0.04). No significant increase in renal 
      sparing was seen when adding RGRT to either 3D-CRT or IMRT. Tolerance doses to 
      the other OAR were not exceeded. CONCLUSIONS: Individualized field margins are 
      essential for gastric irradiation. IMRT plans significantly reduce renal doses, 
      but the benefits of RGRT in gastric irradiation appear to be limited.
FAU - van der Geld, Ylanga G
AU  - van der Geld YG
AD  - Department of Radiation Oncology, VU University Medical Center, Amsterdam, The 
      Netherlands.
FAU - Senan, Suresh
AU  - Senan S
FAU - van Sornsen de Koste, John R
AU  - van Sornsen de Koste JR
FAU - Verbakel, Wilko F A R
AU  - Verbakel WF
FAU - Slotman, Ben J
AU  - Slotman BJ
FAU - Lagerwaard, Frank J
AU  - Lagerwaard FJ
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Analysis of Variance
MH  - *Duodenum/radiation effects
MH  - Heart/radiation effects
MH  - Humans
MH  - Kidney/*radiation effects
MH  - Liver/radiation effects
MH  - *Movement
MH  - Radiation Injuries/*prevention & control
MH  - Radiotherapy, Conformal
MH  - Radiotherapy, Intensity-Modulated
MH  - Respiration
MH  - Retrospective Studies
MH  - Spinal Cord/radiation effects
MH  - *Stomach/radiation effects
MH  - Stomach Neoplasms/diagnostic imaging/*radiotherapy
MH  - Tomography, X-Ray Computed/*methods
EDAT- 2007/09/25 09:00
MHDA- 2007/12/06 09:00
CRDT- 2007/09/25 09:00
PHST- 2007/02/26 00:00 [received]
PHST- 2007/05/29 00:00 [revised]
PHST- 2007/06/05 00:00 [accepted]
PHST- 2007/09/25 09:00 [pubmed]
PHST- 2007/12/06 09:00 [medline]
PHST- 2007/09/25 09:00 [entrez]
AID - S0360-3016(07)01177-7 [pii]
AID - 10.1016/j.ijrobp.2007.06.062 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):903-9. doi: 
      10.1016/j.ijrobp.2007.06.062.