title: Three-dimensional non-coplanar conformal radiotherapy yields better results than traditional beam arrangements for adjuvant treatment of gastric cancer.
abstract: OBJECTIVE
  The current standard of adjuvant treatment for gastric cancer after curative resection is concurrent administration of radiotherapy and 5-fluorouracil-based chemotherapy. The radiation fields are often arranged as anterioposterior-posteroanterior opposed parallel fields with general recommendations for sparing at least two-thirds of one kidney. We investigated whether a better radiation distribution would be achievable with three-dimensional conformal approaches compared with the classic anterioposterior-posteroanterior fields.
  
  
  METHODS
  A total of 19 patients with adenocarcinoma of the stomach were treated with adjuvant chemoradiotherapy using a non-coplanar four-field arrangement. In each case, parallel planning using an anterioposterior-posteroanterior arrangement and a four-field "box" was performed, and the generated plans were subsequently compared for coverage of target volumes and doses to irradiated organs next to the tumor bed. A separate analysis was performed for kidneys exposed to greater and lower doses in each patient. The mean radiation dose and percentage of kidney volume receiving a dose >20 Gy were registered. Statistical analysis was performed using the two-tailed t test.
  
  
  RESULTS
  The clinical target volume was adequately covered in all three plans. In the greater-dose kidney group, all the differences were statistically significant with a benefit for the three-dimensional plan. In the lower-dose kidney group, the differences in the mean radiation dose did not reach the level of statistical significance, and the differences in the kidney volume receiving a dose >20 Gy showed a statistically significant benefit for the three-dimensional plan.
  
  
  CONCLUSIONS
  Non-coplanar three-dimensional-based conformal planning for postoperative radiotherapy for gastric cancer provided the best results regarding kidney and spinal cord exposure with adequate clinical target volume coverage. This technique was readily implemented in clinical practice.
authors.affiliation: Institute of Radiotherapy, Tel Aviv (Sourasky) Medical Center, Tel Aviv University School of Medicine, Tel Aviv, Israel. vjacheslavsoyfer@yahoo.com
authors.forename: Viacheslav
authors.initials: V
authors.lastname: Soyfer
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Corn
authors.forename: Alex
authors.initials: A
authors.lastname: Melamud
authors.forename: Shlomi
authors.initials: S
authors.lastname: Alani
authors.forename: Haim
authors.initials: H
authors.lastname: Tempelhof
authors.forename: Reuben
authors.initials: R
authors.lastname: Agai
authors.forename: Anat
authors.initials: A
authors.lastname: Shmueli
authors.forename: Arie
authors.initials: A
authors.lastname: Figer
authors.forename: Felix
authors.initials: F
authors.lastname: Kovner
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005743:Gastrectomy; D006801:Humans; D007668:Kidney / Q000528:radiation effects*; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000379:methods*; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery