Abstract
The aim of the present study was to compare radiotherapy treatment plans for gastric cancer using intensity-modulated radiotherapy (IMRT) and single/double-arc volumetric modulated arc therapy (SA/DA-VMAT) delivery techniques. A total of 29 postoperative gastric cancer patients were enrolled in this study and each patient was scheduled 5-field IMRT (5F-IMRT), 7-field IMRT (7F-IMRT), SA-VMAT and DA-VMAT techniques. Dose-volume histogram statistics, conformal index (CI), homogeneity index (HI) and monitor units (MUs) were analyzed to compare treatment plans. The DA-VMAT plans exceeded the other three methods in terms of planning tumor volume dose and organs at risk in the kidneys, but not in the liver. DA-VMAT exhibited a better mean CI (0.87±0.03) and HI (0.10±0.01) than the other techniques. In addition, for the kidneys the dose sparing (V13, V18 and mean kidney dose) was improved by DA-VMAT plans. Similar results were observed for MUs. However, 5F-IMRT showed a marginal advantage in V30 and mean dose in normal liver when compared with DA-VMAT. The results of this study suggest that DA-VMAT provides improved tumor coverage when compared with 5F-IMRT, 7F-IMRT and SA-VMAT; however, DA-VMAT exhibits no advantage in liver protection when compared with 5F-IMRT. Further studies are required to establish differences in treatment outcomes among the four technologies.
Highlights
Gastric cancer is the fourth most common type of malignant tumor worldwide [1] and the annual number of novel casesKey words: gastric cancer, intensity‐modulated radiotherapy, volumetric modulated arc therapy, dosimetric comparison is ~95 million
Adjuvant chemoradiotherapy for resectable gastric adenocarcinoma has become the standard treatment for D0 and D2 gastrectomy
Due to the combination of radiotherapy and chemotherapy, treatment‐associated toxicities are enhanced, which often leads to relinquishment of treatment among patients
Summary
Gastric cancer is the fourth most common type of malignant tumor worldwide [1] and the annual number of novel cases. In the INT‐0116 study, 57% of patients experienced grade 3 or 4 toxicity [3]. Ringash et al [5] found that the application of three‐dimensional conformal radiotherapy (3D‐CRT) in patients with gastric cancer, which is different from the 2D radiotherapy used in the INT‐0116 trial, decreased the incidence of grade 2 or higher toxicity to 25%. Similar studies have shown that conformal intensity‐modulated radiation therapy (IMRT) achieves superior planning tumor volume (PTV) target coverage and improved normal tissue sparing [6,7,8]. The National Comprehensive Cancer Network Guidelines recommend either 3D‐CRT or IMRT, it is widely accepted in the medical profession that IMRT is superior to 3D‐CRT in terms of tumor coverage, increased local tumor control probability and dose reduction to certain organs at risk (OARs)
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