title: Intensity modulated radiation therapy (IMRT) is not superior to three-dimensional conformal radiation (3DCRT) for adjuvant gastric radiation: A matched pair analysis.
abstract: OBJECTIVE
  To compare three-dimensional conformal radiation (3DCRT) and Intensity Modulated Radiation Therapy (IG-IMRT) for adjuvant gastric irradiation.
  
  
  METHODS
  From Jan 2010-Aug 2013, all patients undergoing 3DCRT and IG-IMRT were included. Systemic chemotherapy included 1 cycle before and 2 cycles after chemoradiation. Planning Target Volume (PTV) received 45 Gy/25 fractions/5 weeks with concurrent capcetabine 825 mg/m2 bid. Matched pair analysis was performed to evaluate imbalance in two cohorts if any. Common Toxicity Criteria for Adverse Event (CTCAE) vs 3.0 was used to record gastrointestinal (GI), hematological (HL), and renal toxicity during treatment and follow-up. Patterns of recurrence were documented. Mann-Whitney U test was used for statistical comparison.
  
  
  RESULTS
  Of the 51 patients, 26 received 3DCRT and 25 IMRT. IMRT led to decrease in dose received by right and left kidney (12.4 Gy and 7.1 Gy and 29 Gy vs 8.2 Gy; P<0.001). Overall, 17.6% and 19.6% patients had grade II GI and HL toxicity and 3.9% and 5.9% had grade III GI and HL toxicity. No difference was observed in acute grade II-V GI or HL toxicity (11.5% vs 24%, P=0.07; 7.6% vs 20% P=0.20) or late GI, HL, or renal toxicity between 3DCRT and IMRT. No difference was observed in patterns of local relapse (11.5% vs 12%, P=0.14) or overall survival (39% and 38% (P=0.97)) between 3DCRT and IMRT.
  
  
  CONCLUSIONS
  3DCRT and IMRT are equivalent in terms of toxicity and local control.
authors.affiliation: Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Kharghar, Navi Mumbai, India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Chopra
authors.forename: Aditi
authors.initials: A
authors.lastname: Agarwal
authors.forename: Reena
authors.initials: R
authors.lastname: Engineer
authors.forename: Tapas
authors.initials: T
authors.lastname: Dora
authors.forename: Biji
authors.initials: B
authors.lastname: Thomas
authors.forename: Supriya
authors.initials: S
authors.lastname: Sonawone
authors.forename: Siji N
authors.initials: SN
authors.lastname: Paul
authors.forename: Sadhna
authors.initials: S
authors.lastname: Kannan
authors.forename: Prachi
authors.initials: P
authors.lastname: Patil
authors.forename: Shaesta
authors.initials: S
authors.lastname: Mehta
authors.forename: Shyam Kishore
authors.initials: SK
authors.lastname: Shrivastava
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000473:pathology / Q000532:radiotherapy*