Lien Van De Voorde1, Ruben Larue2, Lucas Persoon2, Michel Öllers2, Sebastiaan Nijsten2, Geert Bosmans2, Maaike Berbée2, Ans Swinnen2, Wouter van Elmpt2, Ben Vanneste2, Frank Verhaegen3, Philippe Lambin2. 1. Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, The Netherlands. Electronic address: Lien.vandevoorde@maastro.nl. 2. Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, The Netherlands. 3. Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, The Netherlands; Medical Physics Unit, Department of Oncology, McGill University, Montréal, Canada.
Abstract
PURPOSE: To evaluate whether adaptive radiotherapy for unaccounted stomach changes in patients with adenocarcinoma of the gastroesophageal junction (GEJ) is necessary and whether dose differences could be prevented by giving patients food and fluid instructions before treatment simulation and radiotherapy. MATERIAL AND METHODS:Twenty patients were randomly assigned into two groups: patients with andwithout instructions about restricting food and fluid intake prior to radiotherapy simulation and treatment. Redelineation and offline recalculation of dose distributions based on cone-beam computed tomography (n=100) were performed. Dose-volume parameters were analysed for the clinical target volume extending into the stomach. RESULTS:Four patients who did not receive instructions had a geometric miss (0.7-12 cm(3)) in only one fraction. With instructions, 3 out of 10 patients had a geometric miss (0.1-1.9 cm(3)) in one (n=2) or two (n=1) fractions. The V95% was reduced by more than 5% for one patient, but this underdosage was in an in-air region without further clinical importance. CONCLUSIONS: Giving patients food and fluid instructions for the treatment of GEJ cancer offers no clinical benefit. Using a planning target volume margin of 1cm implies that there is no need for adaptive radiotherapy for GEJ tumours.
RCT Entities:
PURPOSE: To evaluate whether adaptive radiotherapy for unaccounted stomach changes in patients with adenocarcinoma of the gastroesophageal junction (GEJ) is necessary and whether dose differences could be prevented by giving patients food and fluid instructions before treatment simulation and radiotherapy. MATERIAL AND METHODS: Twenty patients were randomly assigned into two groups: patients with and without instructions about restricting food and fluid intake prior to radiotherapy simulation and treatment. Redelineation and offline recalculation of dose distributions based on cone-beam computed tomography (n=100) were performed. Dose-volume parameters were analysed for the clinical target volume extending into the stomach. RESULTS: Four patients who did not receive instructions had a geometric miss (0.7-12 cm(3)) in only one fraction. With instructions, 3 out of 10 patients had a geometric miss (0.1-1.9 cm(3)) in one (n=2) or two (n=1) fractions. The V95% was reduced by more than 5% for one patient, but this underdosage was in an in-air region without further clinical importance. CONCLUSIONS: Giving patients food and fluid instructions for the treatment of GEJ cancer offers no clinical benefit. Using a planning target volume margin of 1cm implies that there is no need for adaptive radiotherapy for GEJ tumours.
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