title: Intensity-modulated radiation therapy significantly improves acute gastrointestinal toxicity in pancreatic and ampullary cancers.
abstract: OBJECTIVE
  Among patients with upper abdominal malignancies, intensity-modulated radiation therapy (IMRT) can improve dose distributions to critical dose-limiting structures near the target. Whether these improved dose distributions are associated with decreased toxicity when compared with conventional three-dimensional treatment remains a subject of investigation.
  
  
  METHODS
  46 patients with pancreatic/ampullary cancer were treated with concurrent chemoradiation (CRT) using inverse-planned IMRT. All patients received CRT based on 5-fluorouracil in a schema similar to Radiation Therapy Oncology Group (RTOG) 97-04. Rates of acute gastrointestinal (GI) toxicity for this series of IMRT-treated patients were compared with those from RTOG 97-04, where all patients were treated with three-dimensional conformal techniques. Chi-square analysis was used to determine if there was a statistically different incidence in acute GI toxicity between these two groups of patients.
  
  
  RESULTS
  The overall incidence of Grade 3-4 acute GI toxicity was low in patients receiving IMRT-based CRT. When compared with patients who had three-dimensional treatment planning (RTOG 97-04), IMRT significantly reduced the incidence of Grade 3-4 nausea and vomiting (0% vs. 11%, p = 0.024) and diarrhea (3% vs. 18%, p = 0.017). There was no significant difference in the incidence of Grade 3-4 weight loss between the two groups of patients.
  
  
  CONCLUSIONS
  IMRT is associated with a statistically significant decrease in acute upper and lower GI toxicity among patients treated with CRT for pancreatic/ampullary cancers. Future clinical trials plan to incorporate the use of IMRT, given that it remains a subject of active investigation.
authors.affiliation: Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Susannah
authors.initials: S
authors.lastname: Yovino
authors.forename: Matthew
authors.initials: M
authors.lastname: Poppe
authors.forename: Salma
authors.initials: S
authors.lastname: Jabbour
authors.forename: Vera
authors.initials: V
authors.lastname: David
authors.forename: Michael
authors.initials: M
authors.lastname: Garofalo
authors.forename: Naimesh
authors.initials: N
authors.lastname: Pandya
authors.forename: Richard
authors.initials: R
authors.lastname: Alexander
authors.forename: Nader
authors.initials: N
authors.lastname: Hanna
authors.forename: William F
authors.initials: WF
authors.lastname: Regine
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000069287:Capecitabine; D016009:Chi-Square Distribution; D003138:Common Bile Duct Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D041981:Gastrointestinal Tract / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil; D000093542:Gemcitabine
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