Abstract
BackgroundTo quantitatively evaluate the safety and related-toxicities of intensity modulated radiotherapy (IMRT) dose–volume histograms (DVHs), as compared to the conventional three-dimensional conformal radiotherapy (3D-CRT), in gynecologic malignancy patients by systematic review of the related publications and meta-analysis.MethodsRelevant articles were retrieved from the PubMed, Embase, and Cochrane Library databases up to August 2011. Two independent reviewers assessed the included studies and extracted data. Pooled average percent irradiated volumes of adjacent non-cancerous tissues were calculated and compared between IMRT and 3D-CRT for a range of common radiation doses (5-45Gy).ResultsIn total, 13 articles comprised of 222 IMRT-treated and 233 3D-CRT-treated patients were included. For rectum receiving doses ≥30 Gy, the IMRT pooled average irradiated volumes were less than those from 3D-CRT by 26.40% (30 Gy, p = 0.004), 27.00% (35 Gy, p = 0.040), 37.30% (40 Gy, p = 0.006), and 39.50% (45 Gy, p = 0.002). Reduction in irradiated small bowel was also observed for IMRT-delivered 40 Gy and 45 Gy (by 17.80% (p = 0.043) and 17.30% (p = 0.012), respectively), as compared with 3D-CRT. However, there were no significant differences in the IMRT and 3D-CRT pooled average percent volumes of irradiated small bowel or rectum from lower doses, or in the bladder or bone marrow from any of the doses. IMRT-treated patients did not experience more severe acute or chronic toxicities than 3D-CRT-treated patients.ConclusionsIMRT-delivered high radiation dose produced significantly less average percent volumes of irradiated rectum and small bowel than 3D-CRT, but did not differentially affect the average percent volumes in the bladder and bone marrow.
Highlights
To quantitatively evaluate the safety and related-toxicities of intensity modulated radiotherapy (IMRT) dose–volume histograms (DVHs), as compared to the conventional three-dimensional conformal radiotherapy (3D-CRT), in gynecologic malignancy patients by systematic review of the related publications and meta-analysis
Criteria for study inclusion and exclusion A study was selected for inclusion if it provided information on DVHs of different irradiated organs that had been treated with IMRT or Three-dimensional conformal radiotherapy (3D-CRT)
Characteristics of the included studies In total, 13 articles, which compared the extents of DVHs in IMRT and 3D-CRT for endometrial and cervical cancer patients, were included
Summary
To quantitatively evaluate the safety and related-toxicities of intensity modulated radiotherapy (IMRT) dose–volume histograms (DVHs), as compared to the conventional three-dimensional conformal radiotherapy (3D-CRT), in gynecologic malignancy patients by systematic review of the related publications and meta-analysis. In the late 1990s, the technique of three-dimensional conformal radiation therapy (3D-CRT) emerged as a preferred treatment for gynecologic malignancies, since it gave better target coverage and significantly reduced the radiation exposure to the bladder [6]. This technique did not appreciably reduce the amount of radiation exposure to the intestine or rectum [7]. IMRT has become a common strategy for whole pelvic radiotherapy (WPRT), and has been shown to offer more accurate dose distributions and tighter dose gradients to targets and to reduce toxic risk and undesirable side effects to the rectum, bladder, small bowel, and pelvic bones [15,16,17,18]
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