Dosimetric and clinical toxicity comparison of critical organ preservation with three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and RapidArc for the treatment of locally advanced cancer of the pancreatic head

  • L. Jin Shandong Cancer Hospital; University of Jinan
  • R. Wang Shandong Cancer Hospital
  • S. Jiang Shandong Cancer Hospital
  • J. Yue Shandong Cancer Hospital
  • T. Liu Shandong Cancer Hospital
  • X. Dou Shandong Cancer Hospital
  • K. Zhu Shandong Cancer Hospital
  • R. Feng Shandong Cancer Hospital
  • X. Xu Shandong Cancer Hospital
  • D. Chen Shandong Cancer Hospital; University of Jinan
  • Y. Yin Shandong Cancer Hospital
Keywords: Dosimetric comparisons, 3d-crt, imrt, RapidArc, pancreatic cancer, organ preservation

Abstract

Purpose

We compared dosimetry and clinical toxicity for 3-dimensional conformal radiotherapy (3D-crt), intensity-modulated radiotherapy (imrt), and RapidArc (Varian Medical Systems, Palo Alto, CA, U.S.A.) in locally advanced pancreatic cancer (lapcc). We hypothesized that the technique with better sparing of organs at risk (oars) and better target dose distributions could lead to decreased clinical toxicity.

Methods

The study analyzed 280 patients with lapcc who had undergone radiotherapy. The dosimetry comparison was performed using 20 of those patients. Dose–volume histograms for the target volume and the oars were compared. The clinical toxicity comparison used the 280 patients who received radiation with 3D-crt, imrt, or RapidArc.

Results

Compared with 3D-crt, RapidArc and imrt both achieved a better conformal index, homogeneity index, V95%, and V110%. Compared with 3D-crt or imrt, RapidArc reduced the V10, V20, and mean dose to duodenum, the V20 of the right kidney, and the liver mean dose. Compared with 3D-crt, RapidArc reduced the V35, and V45 of duodenum, the mean dose to small bowel, and the V15 of right kidney. The incidences of grades 3 and 4 diarrhea (p = 0.037) and anorexia (p = 0.042) were lower with RapidArc than with 3D-crt, and the incidences of grades 3 and 4 diarrhea (p = 0.027) were lower with RapidArc than with imrt.

Conclusions

Compared with 3D-crt or imrt, RapidArc showed better sparing of oars, especially duodenum, small bowel, and right kidney. Also, fewer acute grades 3 and 4 gastrointestinal toxicities were seen with RapidArc than with 3D-crt or imrt. A technique with better sparing of oars and better target dose distributions could result in decreased clinical toxicities during radiation treatment for lapcc.

Author Biographies

L. Jin, Shandong Cancer Hospital; University of Jinan
Department of Radiation Oncology; School of Medicine and Life Sciences, Shandong Academy of Medical Sciences
R. Wang, Shandong Cancer Hospital
Department of Radiation Oncology
S. Jiang, Shandong Cancer Hospital
Department of Radiation Oncology
J. Yue, Shandong Cancer Hospital
Department of Radiation Oncology
T. Liu, Shandong Cancer Hospital
Department of Radiation Oncology
X. Dou, Shandong Cancer Hospital
Department of Radiation Oncology
K. Zhu, Shandong Cancer Hospital
Department of Radiation Oncology
R. Feng, Shandong Cancer Hospital
Department of Radiation Oncology
X. Xu, Shandong Cancer Hospital
Department of Radiation Oncology
D. Chen, Shandong Cancer Hospital; University of Jinan
Department of Radiation Oncology; School of Medicine and Life Sciences, Shandong Academy of Medical Sciences
Y. Yin, Shandong Cancer Hospital
Department of Radiation Oncology
Published
2015-11-20
How to Cite
Jin, L., Wang, R., Jiang, S., Yue, J., Liu, T., Dou, X., Zhu, K., Feng, R., Xu, X., Chen, D., & Yin, Y. (2015). Dosimetric and clinical toxicity comparison of critical organ preservation with three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and RapidArc for the treatment of locally advanced cancer of the pancreatic head. Current Oncology, 23(1), e41-e48. https://doi.org/10.3747/co.23.2771
Section
Radiation Oncology