title: Comparison of intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy as adjuvant therapy for gastric cancer.
abstract: BACKGROUND
  The current study was performed to compare the clinical outcomes and toxicity in patients treated with postoperative chemoradiotherapy for gastric cancer using intensity-modulated radiotherapy (IMRT) versus 3-dimensional conformal radiotherapy (3D CRT).
  
  
  METHODS
  Fifty-seven patients with gastric or gastroesophageal junction cancer were treated postoperatively: 26 with 3D CRT and 31 with IMRT. Concurrent chemotherapy was capecitabine (n=31), 5-fluorouracil (5-FU) (n=25), or none (n=1). The median radiation dose was 45 Gy. Dose volume histogram parameters for kidney and liver were compared between treatment groups.
  
  
  RESULTS
  The 2-year overall survival rates for 3D CRT versus IMRT were 51% and 65%, respectively (P=.5). Four locoregional failures occurred each in the 3D CRT (15%) and the IMRT (13%) patients. Grade>or=2 acute gastrointestinal toxicity was found to be similar between the 3D CRT and IMRT patients (61.5% vs 61.2%, respectively) but more treatment breaks were needed (3 vs 0, respectively). The median serum creatinine from before radiotherapy to most recent creatinine was unchanged in the IMRT group (0.80 mg/dL) but increased in the 3D CRT group from 0.80 mg/dL to 1.0 mg/dL (P=.02). The median kidney mean dose was higher in the IMRT versus the 3D CRT group (13.9 Gy vs 11.1 Gy; P=.05). The median kidney V20 was lower for the IMRT versus the 3D CRT group (17.5% vs 22%; P=.17). The median liver mean dose for IMRT and 3D CRT was 13.6 Gy and 18.6 Gy, respectively (P=.19). The median liver V30 was 16.1% and 28%, respectively (P<.001).
  
  
  CONCLUSIONS
  Adjuvant chemoradiotherapy was well tolerated. IMRT was found to provide sparing to the liver and possibly renal function.
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, California 94305-5847, USA.
authors.forename: A Yuriko
authors.initials: AY
authors.lastname: Minn
authors.forename: Annie
authors.initials: A
authors.lastname: Hsu
authors.forename: Trang
authors.initials: T
authors.lastname: La
authors.forename: Pamela
authors.initials: P
authors.lastname: Kunz
authors.forename: George A
authors.initials: GA
authors.lastname: Fisher
authors.forename: James M
authors.initials: JM
authors.lastname: Ford
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.forename: Brendan
authors.initials: B
authors.lastname: Visser
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
authors.forename: Albert C
authors.initials: AC
authors.lastname: Koong
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome