title: Intensity-modulated radiotherapy in patients with locally advanced rectal cancer reduces volume of bowel treated to high dose levels.
abstract: OBJECTIVE
  To investigate the potential for intensity-modulated radiotherapy (IMRT) to spare the bowel in rectal tumors.
  
  
  METHODS
  The targets (pelvic nodal and rectal volumes), bowel, and bladder were outlined in 5 patients. All had conventional, three-dimensional conformal RT and forward-planned multisegment three-field IMRT plans compared with inverse-planned simultaneous integrated boost nine-field equally spaced IMRT plans. Equally spaced seven-field and five-field and five-field, customized, segmented IMRT plans were also evaluated.
  
  
  RESULTS
  Ninety-five percent of the prescribed dose covered at least 95% of both planning target volumes using all but the conventional plan (mean primary and pelvic planning target volume receiving 95% of the prescribed dose was 32.8 +/- 13.7 Gy and 23.7 +/- 4.87 Gy, respectively), reflecting a significant lack of coverage. The three-field forward planned IMRT plans reduced the volume of bowel irradiated to 45 Gy and 50 Gy by 26% +/- 16% and 42% +/- 27% compared with three-dimensional conformal RT. Additional reductions to 69 +/- 51 cm(3) to 45 Gy and 20 +/- 21 cm(3) to 50 Gy were obtained with the nine-field equally spaced IMRT plans-64% +/- 11% and 64% +/- 20% reductions compared with three-dimensional conformal RT. Reducing the number of beams and customizing the angles for the five-field equally spaced IMRT plan did not significantly reduce bowel sparing.
  
  
  CONCLUSIONS
  The bowel volume irradiated to 45 Gy and 50 Gy was significantly reduced with IMRT, which could potentially lead to less bowel toxicity. Reducing the number of beams did not reduce bowel sparing and the five-field customized segmented IMRT plan is a reasonable technique to be tested in clinical trials.
authors.affiliation: Department of Clinical Oncology, Royal Marsden NHS Trust, Sutton, Surrey, United Kingdom.
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Guerrero Urbano
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Henrys
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Adams
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Norman
authors.forename: James L
authors.initials: JL
authors.lastname: Bedford
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Harrington
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Nutting
authors.forename: David P
authors.initials: DP
authors.lastname: Dearnaley
authors.forename: Diana M
authors.initials: DM
authors.lastname: Tait
mesh_terms: D006801:Humans; D007422:Intestines / Q000528:radiation effects*; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000528:radiation effects*