PURPOSE: Involved-field radiation therapy of the stomach is often used in the curative treatment of gastric lymphoma. Yet, the optimal technique to irradiate the stomach with minimal morbidity has not been well established. This study was designed to evaluate treatment planning alternatives for stomach irradiation, including intensity-modulated radiation therapy (IMRT), to determine which approach resulted in improved dose distribution and to identify patient-specific anatomic factors that might influence a treatment planning choice. METHODS AND MATERIALS: Fifteen patients with lymphoma of the stomach (14 mucosa-associated lymphoid tissue lymphomas and 1 diffuse large B-cell lymphoma) were categorized into 3 types, depending on the geometric relationship between the planning target volume (PTV) and kidneys. AP/PA and 3D conformal radiation therapy (3DCRT) plans were generated for each patient. IMRT was planned for 4 patients with challenging geometric relationship between the PTV and the kidneys to determine whether it was advantageous to use IMRT. RESULTS: For type I patients (no overlap between PTV and kidneys), there was essentially no benefit from using 3DCRT over AP/PA. However, for patients with PTVs in close proximity to the kidneys (type II) or with high degree of overlap (type III), the 4-field 3DCRT plans were superior, reducing the kidney V(15 Gy) by approximately 90% for type II and 50% for type III patients. For type III, the use of a 3DCRT plan rather than an AP/PA plan decreased the V(15 Gy) by approximately 65% for the right kidney and 45% for the left kidney. In the selected cases, IMRT led to a further decrease in left kidney dose as well as in mean liver dose. CONCLUSIONS: The geometric relationship between the target and kidneys has a significant impact on the selection of the optimum beam arrangement. Using 4-field 3DCRT markedly decreases the kidney dose. The addition of IMRT led to further incremental improvements in the left kidney and liver dose in selected patients.
PURPOSE: Involved-field radiation therapy of the stomach is often used in the curative treatment of gastric lymphoma. Yet, the optimal technique to irradiate the stomach with minimal morbidity has not been well established. This study was designed to evaluate treatment planning alternatives for stomach irradiation, including intensity-modulated radiation therapy (IMRT), to determine which approach resulted in improved dose distribution and to identify patient-specific anatomic factors that might influence a treatment planning choice. METHODS AND MATERIALS: Fifteen patients with lymphoma of the stomach (14 mucosa-associated lymphoid tissue lymphomas and 1 diffuse large B-cell lymphoma) were categorized into 3 types, depending on the geometric relationship between the planning target volume (PTV) and kidneys. AP/PA and 3D conformal radiation therapy (3DCRT) plans were generated for each patient. IMRT was planned for 4 patients with challenging geometric relationship between the PTV and the kidneys to determine whether it was advantageous to use IMRT. RESULTS: For type Ipatients (no overlap between PTV and kidneys), there was essentially no benefit from using 3DCRT over AP/PA. However, for patients with PTVs in close proximity to the kidneys (type II) or with high degree of overlap (type III), the 4-field 3DCRT plans were superior, reducing the kidney V(15 Gy) by approximately 90% for type II and 50% for type III patients. For type III, the use of a 3DCRT plan rather than an AP/PA plan decreased the V(15 Gy) by approximately 65% for the right kidney and 45% for the left kidney. In the selected cases, IMRT led to a further decrease in left kidney dose as well as in mean liver dose. CONCLUSIONS: The geometric relationship between the target and kidneys has a significant impact on the selection of the optimum beam arrangement. Using 4-field 3DCRT markedly decreases the kidney dose. The addition of IMRT led to further incremental improvements in the left kidney and liver dose in selected patients.
Authors: Gabriele Reinartz; Uwe Haverkamp; Ramona Wullenkord; Philipp Lehrich; Jan Kriz; Florian Büther; Klaus Schäfers; Michael Schäfers; Hans Theodor Eich Journal: Strahlenther Onkol Date: 2016-02-22 Impact factor: 3.621
Authors: Gabriele Reinartz; Regina P Pyra; Georg Lenz; Rüdiger Liersch; Georg Stüben; Oliver Micke; Kay Willborn; Clemens F Hess; Andreas Probst; Rainer Fietkau; Ralf Jany; Jürgen Schultze; Christian Rübe; Carsten Hirt; Wolfgang Fischbach; Martin Bentz; Severin Daum; Christiane Pott; Markus Tiemann; Peter Möller; Andreas Neubauer; Martin Wilhelm; Normann Willich; Wolfgang E Berdel; Hans T Eich Journal: Strahlenther Onkol Date: 2019-03-11 Impact factor: 3.621
Authors: Sang-Won Kim; Do Hoon Lim; Yong Chan Ahn; Won Seog Kim; Seok Jin Kim; Young Hyeh Ko; Kyoung-Mee Kim Journal: World J Gastroenterol Date: 2013-09-28 Impact factor: 5.742