Department of Radiation Oncology, Stanford University, Stanford, California 94305-5847, USA.
Cancer. 2010 Aug 15;116(16):3943-52. doi: 10.1002/cncr.25246.
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).
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.
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).
Adjuvant chemoradiotherapy was well tolerated. IMRT was found to provide sparing to the liver and possibly renal function.
本研究旨在比较使用调强放疗（IMRT）与三维适形放疗（3D CRT）对胃癌患者进行术后放化疗的临床结果和毒性。
57 例胃癌或胃食管交界处癌患者术后接受治疗：26 例接受 3D CRT，31 例接受 IMRT。同期化疗药物为卡培他滨（n=31）、5-氟尿嘧啶（5-FU）（n=25）或无（n=1）。中位放疗剂量为 45 Gy。比较两组患者的肾脏和肝脏剂量体积直方图参数。
3D CRT 与 IMRT 的 2 年总生存率分别为 51%和 65%（P=.5）。3D CRT 组（15%）和 IMRT 组（13%）各有 4 例局部区域复发。3D CRT 组和 IMRT 组的急性胃肠道毒性≥2 级的发生率相似（61.5% vs 61.2%），但需要更多的治疗中断（3 次 vs 0 次）。IMRT 组从放疗前到最近一次血清肌酐中位数无变化（0.80 mg/dL），而 3D CRT 组从 0.80 mg/dL 增加至 1.0 mg/dL（P=.02）。IMRT 组的肾脏平均剂量中位数高于 3D CRT 组（13.9 Gy 与 11.1 Gy；P=.05）。IMRT 组的肾脏 V20 中位数低于 3D CRT 组（17.5%与 22%；P=.17）。IMRT 和 3D CRT 的肝脏平均剂量中位数分别为 13.6 Gy 和 18.6 Gy（P=.19）。肝脏 V30 的中位数分别为 16.1%和 28%（P<.001）。
辅助放化疗耐受性良好。IMRT 可减少肝脏和可能的肾功能损伤。
